Morriston Hospital, Heol Maes Eglwys, Swansea, SA6 6NL, UK.
University Hospital of Wales, Heath Park Way, Cardiff, CF14 4XW, UK.
Best Pract Res Clin Endocrinol Metab. 2018 Dec;32(6):847-859. doi: 10.1016/j.beem.2018.12.001. Epub 2018 Dec 6.
Sporadic primary hyperparathyroidism (pHPT) is the commonest cause of hypercalcaemia in the ambulatory population. It has a female preponderance and its incidence is increasing. In 85% of cases it is caused by a single parathyroid adenoma, with four gland hyperplasia in up to 20%. Parathyroidectomy is the only cure and bilateral neck exploration remains the gold standard to achieve this. Several adjuncts have been developed to improve success rates or limit the extent of surgery. Pre-operative localisation permits planned targeted surgery. Ultrasound scanning and scintigraphy are the most commonly employed, although 4DCT has become a useful modality in complex cases. However, excellent rates of biochemical cure can be achieved in specialist centres when pre-operative imaging is negative. Pre-operative prediction models and intra-operative parathyroid hormone (ioPTH) assist, with high sensitivity, to predict single gland disease. Reoperations present a major challenge to the endocrine surgeon.
散发性甲状旁腺功能亢进症（pHPT）是门诊人群中常见的高钙血症的病因。它在女性中更为常见，其发病率正在增加。在 85%的病例中，它是由单个甲状旁腺腺瘤引起的，多达 20%的病例是由四个腺体增生引起的。甲状旁腺切除术是唯一的治愈方法，双侧颈部探查仍然是实现这一目标的金标准。已经开发了几种辅助方法来提高成功率或限制手术范围。术前定位允许计划靶向手术。超声扫描和闪烁扫描是最常用的方法，尽管 4DCT 在复杂病例中已成为一种有用的方式。然而，在术前影像学检查为阴性的情况下，在专科中心可以实现出色的生化治愈率。术前预测模型和术中甲状旁腺激素（ioPTH）检测具有较高的敏感性，有助于预测单腺疾病。再次手术对内分泌外科医生来说是一个重大挑战。
