Division of Endocrinology, College of Physicians and Surgeons, Columbia University, New York, NY, USA.
Division of Endocrinology, College of Physicians and Surgeons, Columbia University, New York, NY, USA; Division of Endocrinology and Diabetes, Agamenon Magalhães Hospital, Brazilian Ministry of Health, University of Pernambuco, Medical School, Recife, Brazil.
Lancet. 2018 Jan 13;391(10116):168-178. doi: 10.1016/S0140-6736(17)31430-7. Epub 2017 Sep 17.
Primary hyperparathyroidism is a common endocrine disorder of calcium metabolism characterised by hypercalcaemia and elevated or inappropriately normal concentrations of parathyroid hormone. Almost always, primary hyperparathyroidism is due to a benign overgrowth of parathyroid tissue either as a single gland (80% of cases) or as a multiple gland disorder (15-20% of cases). Primary hyperparathyroidism is generally discovered when asymptomatic but the disease always has the potential to become symptomatic, resulting in bone loss and kidney stones. In countries where biochemical screening tests are not common, symptomatic primary hyperparathyroidism tends to predominate. Another variant of primary hyperparathyroidism has been described in which the serum calcium concentration is within normal range but parathyroid hormone is elevated in the absence of any obvious cause. Primary hyperparathyroidism can be cured by removal of the parathyroid gland or glands but identification of patients who are best advised to have surgery requires consideration of the guidelines that are regularly updated. Recommendations for patients who do not undergo parathyroid surgery include monitoring of serum calcium concentrations and bone density.
原发性甲状旁腺功能亢进症是一种常见的钙代谢内分泌紊乱，其特征是高钙血症和甲状旁腺激素升高或不适当的正常浓度。几乎所有的原发性甲状旁腺功能亢进症都是由于甲状旁腺组织的良性过度生长引起的，要么是单个腺体（80%的病例），要么是多个腺体疾病（15-20%的病例）。原发性甲状旁腺功能亢进症通常在无症状时被发现，但这种疾病总是有可能出现症状，导致骨丢失和肾结石。在没有生化筛查测试的国家，症状性原发性甲状旁腺功能亢进症往往更为常见。另一种原发性甲状旁腺功能亢进症的变体已被描述，其中血清钙浓度在正常范围内，但甲状旁腺激素在没有任何明显原因的情况下升高。通过切除甲状旁腺或腺体可以治愈原发性甲状旁腺功能亢进症，但要确定哪些患者最适合手术，需要考虑定期更新的指南。不接受甲状旁腺手术的患者的建议包括监测血清钙浓度和骨密度。
