Icard P, Fulla Y, Bonnichon P, Sarfati G, Ingrand J, Olszowy P, Chapuis Y
Clinique chirurgicale, Hôpital Cochin, Paris.
Presse Med. 1987 Dec 19;16(44):2203-6.
The increase of nephrogenic cyclic AMP is an excellent index of parathyroid hypersecretion. A successful treatment of primary hyperparathyroidism results in a rapid fall in nephrogenic cAMP. In a series of 24 patients with proven primary hyperparathyroidism (hyperplasia 3, adenoma 21) and 2 patients with suspected hyperparathyroidism, the success of surgical excision was evaluated by measuring the urinary cAMP/urinary creatinine ratio (R), which in the absence of renal impairment, is proportional to the level of nephrogenic cAMP. Sequential assays of urinary cAMP and creatinine were performed during surgery; laboratory results were available within less than one hour. Among 22 patients with elevated baseline value or R, R became normal in 18 and decreased by more than 50% in 3; these findings suggested that the operation would be successful. In 1 case, R was not measured as the patient had impaired renal function. In another patient with normal baseline value of R, R did not significantly decrease after excision. Surgery failed in 1 patient, although the high value of R at the end of the operation should have prompted us to continue. Finally, in 2 patients the diagnosis was erroneous since R was lower than 0.5 as in controls. Surgeons, therefore, now have a reliable biochemical method at their disposal, but its use will be limited by its cost and complexity.
肾源性环磷酸腺苷（cAMP）的增加是甲状旁腺分泌过多的一个良好指标。原发性甲状旁腺功能亢进的成功治疗会导致肾源性cAMP迅速下降。在一系列24例经证实的原发性甲状旁腺功能亢进患者（增生3例，腺瘤21例）和2例疑似甲状旁腺功能亢进患者中，通过测量尿cAMP/尿肌酐比值（R）来评估手术切除的成功率，在没有肾功能损害的情况下，该比值与肾源性cAMP水平成正比。手术期间对尿cAMP和肌酐进行连续检测；实验室结果在不到一小时内即可获得。在22例基线值或R升高的患者中，18例R恢复正常，3例下降超过50%；这些结果表明手术将会成功。1例患者因肾功能受损未测量R。另1例患者R基线值正常，切除后R未显著下降。1例患者手术失败，尽管手术结束时R值较高本应促使我们继续进行。最后，2例患者的诊断有误，因为其R值低于对照组的0.5。因此，外科医生现在有了一种可靠的生化方法可供使用，但其使用将受到成本和复杂性的限制。
