Al-Thani Hassan, El-Matbouly Moamena, Al-Sulaiti Maryam, Asim Mohammad, Majzoub Ahmad, Tabeb Abdelhakem, El-Menyar Ayman
Department of Surgery, Hamad General Hospital, Doha, Qatar.
Clinical Research, Trauma & Vascular Surgery, Hamad General Hospital, Doha, Qatar,
Ther Clin Risk Manag. 2018 Jul 31;14:1337-1345. doi: 10.2147/TCRM.S160896. eCollection 2018.
Hyperparathyroidism is a frequent endocrine disorder with variable clinical manifestations and outcomes. We aimed to evaluate clinical presentations, management and outcomes of hyperparathyroidism.
A retrospective study was conducted to include all patients presented with hyperparathyroidism between 1995 and 2014 at a single tertiary hospital with an average follow-up period of 46 months. Data were reviewed for clinical presentations, diagnostic work-up, intraoperative findings, management, and outcomes.
We identified 161 patients with hyperparathyroidism; 69% were females and the mean age was 49.4±15 years. Patients presented mainly with musculoskeletal (65.8%), renal (37.3%), gastrointestinal tract (53.8%) and neuropsychiatric (8.8%) manifestations. At presentation, mean serum calcium and parathyroid hormone levels were elevated while mean vitamin D level was lower. Sestamibi-Tc (MIBI) scintigraphy was done for 134 patients (83.2%) and was positive in 94 (70%). Primary hyperparathyroidism (67.7%) was the most frequent diagnosis followed by secondary (29.8%) and tertiary hyperparathyroidism (2.5%). The frequent indication for surgery was hypercalcemia (67.3%), bone disease (35.6%) and renal calculi (28.9%). The main postoperative pathology was parathyroid adenoma (63.1%) followed by hyperplasia (37.3%). Fourteen (8.9%) and 18 (11.4%) patients had persistent and recurrent hyperparathyroidism, respectively. Autotransplantation of parathyroid tissue was done in 36 cases.
Primary hyperparathyroidism is the most frequent cause of the parathyroid disease. Parathyroidectomy is the effective surgical approach in symptomatic patients. Further studies are needed to establish the association between vitamin D levels, renal disorders and persistent or recurrent hyperparathyroidism.
甲状旁腺功能亢进是一种常见的内分泌疾病，临床表现和预后各不相同。我们旨在评估甲状旁腺功能亢进的临床表现、治疗及预后。
进行一项回顾性研究，纳入1995年至2014年间在一家三级医院就诊的所有甲状旁腺功能亢进患者，平均随访期为46个月。回顾患者的临床表现、诊断检查、术中发现、治疗及预后等数据。
我们共确定了161例甲状旁腺功能亢进患者；其中69%为女性，平均年龄为49.4±15岁。患者主要表现为肌肉骨骼系统（65.8%）、肾脏（37.3%）、胃肠道（53.8%）及神经精神系统（8.8%）症状。就诊时，患者血清钙和甲状旁腺激素水平平均升高，而维生素D水平平均降低。134例患者（83.2%）接受了甲氧基异丁基异腈-锝（MIBI）闪烁扫描，其中94例（70%）结果为阳性。最常见的诊断为原发性甲状旁腺功能亢进（67.7%），其次是继发性（29.8%）和三发性甲状旁腺功能亢进（2.5%）。手术的常见指征为高钙血症（67.3%）、骨病（35.6%）和肾结石（28.9%）。术后主要病理结果为甲状旁腺腺瘤（63.1%），其次为增生（37.3%）。分别有14例（8.9%）和18例（11.4%）患者出现持续性和复发性甲状旁腺功能亢进。36例患者进行了甲状旁腺组织自体移植。
原发性甲状旁腺功能亢进是甲状旁腺疾病最常见的病因。甲状旁腺切除术是有症状患者的有效手术方法。需要进一步研究以确定维生素D水平、肾脏疾病与持续性或复发性甲状旁腺功能亢进之间的关联。
