Section of Endocrine Surgery, UCLA David Geffen School of Medicine, Los Angeles, CA.
Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA.
Surgery. 2019 Jan;165(1):99-104. doi: 10.1016/j.surg.2018.04.088. Epub 2018 Nov 9.
Patients with primary hyperparathyroidism are at risk for skeletal and renal end-organ damage.
We studied patients with biochemically confirmed primary hyperparathyroidism from 1995-2014 and quantified the frequency of osteoporosis, nephrolithiasis, hypercalciuria, and decrease in renal function.
The cohort comprised 9,485 patients. In total, 3,303 (35%) had preexisting end-organ effects (osteoporosis, 24%; nephrolithiasis, 10%; hypercalciuria, 5%). Of 6,182 remaining patients, 1,769 (29%) exhibited progression to 1 or more end-organ effects over a median 3.7 years. Among patients with classic primary hyperparathyroidism (calcium and parathyroid hormone increased), progression was unrelated to the degree of hypercalcemia (calcium >11.5 mg/dL, hazard ratio 1.03, 95% confidence interval 0.85-1.25; 11.1-11.5 mg/dL, HR 1.07, 95% confidence interval 0.93-1.23; 10.5-11.0 mg/dL = reference). Patients with nonclassic primary hyperparathyroidism (calcium increased, parathyroid hormone 40-65 pg/mL) had a lesser risk of progression (calcium >11.5 mg/dL, hazard ratio 0.68, 95% confidence interval 0.50-0.94; 11.1-11.5 mg/dL, hazard ratio 0.68, 95% confidence interval 0.56-0.82; 10.5-11.0 mg/dL, hazard ratio 0.66, 95% confidence interval 0.59-0.74). End-organ damage developed before or within 5 years of diagnosis for 62% of patients.
End-organ manifestations of primary hyperparathyroidism develop before biochemical diagnosis or within 5 years in most patients. End-organ damage occurred more frequently in patients with classic primary hyperparathyroidism versus nonclassic primary hyperparathyroidism, regardless of severity of hypercalcemia.
原发性甲状旁腺功能亢进症患者存在骨骼和肾脏靶器官损伤的风险。
我们研究了 1995 年至 2014 年间经生化确诊的原发性甲状旁腺功能亢进症患者，并对骨质疏松症、肾结石、高钙尿症和肾功能下降的发生率进行了量化。
该队列包含 9485 例患者。共有 3303 例（35%）患者存在预先存在的靶器官效应（骨质疏松症 24%，肾结石 10%，高钙尿症 5%）。在其余 6182 例患者中，有 1769 例（29%）患者在中位 3.7 年内进展为 1 种或多种靶器官疾病。在经典原发性甲状旁腺功能亢进症（钙和甲状旁腺激素升高）患者中，进展与高钙血症的严重程度无关（钙>11.5mg/dL，风险比 1.03，95%置信区间 0.85-1.25；11.1-11.5mg/dL，HR 1.07，95%置信区间 0.93-1.23；10.5-11.0mg/dL=参考）。非经典原发性甲状旁腺功能亢进症（钙升高，甲状旁腺激素 40-65pg/mL）患者的进展风险较低（钙>11.5mg/dL，风险比 0.68，95%置信区间 0.50-0.94；11.1-11.5mg/dL，风险比 0.68，95%置信区间 0.56-0.82；10.5-11.0mg/dL，风险比 0.66，95%置信区间 0.59-0.74）。62%的患者在诊断前或诊断后 5 年内发生靶器官损害。
大多数原发性甲状旁腺功能亢进症患者在生化诊断前或 5 年内发生靶器官表现。经典原发性甲状旁腺功能亢进症患者比非经典原发性甲状旁腺功能亢进症患者发生靶器官损害更为常见，而与高钙血症的严重程度无关。
