Orr Lauren E, McKenzie Travis J, Thompson Geoffrey B, Farley David R, Wermers Robert A, Lyden Melanie L
Department of Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
Division of Endocrinology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
World J Surg. 2018 Feb;42(2):409-414. doi: 10.1007/s00268-017-4323-x.
Criteria for diagnosing primary hyperparathyroidism (PHPT) include hypercalcemia in the presence of parathyroid hormone (PTH) levels that are either elevated (classic PHPT) or normal but non-suppressed. However, there is no standard definition of what constitutes normal non-suppressed levels, and data are lacking regarding the potential for surgical cure in these patients.
A retrospective review of patients undergoing parathyroidectomy for sporadic PHPT between 2012 and 2014 was performed. Patients with normal PTH were compared to classic PHPT patients to assess demographics, imaging, operative findings, and outcomes.
In total, 332 patients met study criteria, and 60 (18%) had normal PTH levels. Negative sestamibi scans were seen more often with normal PTH levels (18.3 vs. 4.8%, p < 0.001). Patients with normal PTH were more likely to have ≥2 glands removed (26.7 vs. 14.3%, p = 0.02), and the specimens were more likely to be classified as only mildly hypercellular or normocellular (20 vs. 2.9%, p < 0.001). Average follow-up was 24 months (range 6-55). Cure rate was 88% in the normal PTH group, compared to 96% in classic PHPT (p = 0.02). Among patients with normal PTH, those with PTH ≤ 55 pg/mL had an 83% cure rate, whereas those with PTH 56-65 had a 96% cure rate (p = 0.12).
Parathyroidectomy can have a high cure rate in the context of normal PTH levels despite an increased likelihood of negative imaging and multigland resection. Operative success is equivalent to classic PHPT when PTH levels are > 55 pg/mL.
原发性甲状旁腺功能亢进症（PHPT）的诊断标准包括血钙升高，同时甲状旁腺激素（PTH）水平升高（典型PHPT）或正常但未被抑制。然而，对于什么构成正常未被抑制水平并没有标准定义，并且缺乏关于这些患者手术治愈可能性的数据。
对2012年至2014年间因散发性PHPT接受甲状旁腺切除术的患者进行回顾性研究。将PTH正常的患者与典型PHPT患者进行比较，以评估人口统计学、影像学、手术发现和结果。
共有332例患者符合研究标准，其中60例（18%）PTH水平正常。PTH水平正常的患者更常出现阴性甲氧基异丁基异腈扫描（18.3%对4.8%，p<0.001）。PTH正常的患者更有可能切除≥2个腺体（26.7%对14.3%，p = 0.02），并且标本更有可能被分类为仅轻度细胞增多或正常细胞（20%对2.9%，p<0.001）。平均随访时间为24个月（范围6 - 55个月）。PTH正常组的治愈率为88%，而典型PHPT组为96%（p = 0.02）。在PTH正常的患者中，PTH≤55 pg/mL的患者治愈率为83%，而PTH为56 - 65的患者治愈率为96%（p = 0.12）。
尽管阴性影像学和多腺体切除的可能性增加，但在PTH水平正常的情况下，甲状旁腺切除术仍可具有较高的治愈率。当PTH水平>55 pg/mL时，手术成功率与典型PHPT相当。
