Medas Fabio, Erdas Enrico, Loi Giulia, Podda Francesco, Barca Lucia, Pisano Giuseppe, Calò Pietro Giorgio
Department of Surgical Sciences, University of Cagliari, Cagliari, Italy.
Center for the Study of Liver Diseases, Department of Medical Sciences "M. Aresu", University of Cagliari, Cagliari, Italy.
BMC Surg. 2019 Apr 24;18(Suppl 1):124. doi: 10.1186/s12893-018-0459-3.
Primary hyperparathyroidism is a common endocrine disorder. Hypercalcemia with normal PTH levels is very unusual and can lead to diagnostic difficulties. There are very few very few studies in the literature and all with limited numerical samples. The goal of the present study was to determine the real incidence and characteristics of primary hyperparathyroidism with normal PTH and to evaluate if intraoperative PTH testing is useful in these patients.
We performed a retrospective review of 314 patients who had undergone parathyroidectomy to treat primary hyperparathyroidism between January 2002 and December 2016. Patients were divided in two groups according to biochemical preoperative findings: in Group A were included patients with normal serum PTH, in Group B those with increased serum PTH.
Nine patients (3.7%) were included in group A and 235 in group B. Patients in group A were younger (51.5 ± 12.9 years vs 59.6 ± 12.5); preoperative serum calcium and the incidence of coexisting thyroid disease were similar between the two groups. Symptomatic patients were more frequent in Group A (77.8% vs 39.1%; p = 0.048). There were no significant differences regarding preoperative localization studies and surgical procedure. Intraoperative PTH determination demonstrated sensitivity of 86% in group A and 97% in group B, specificity and positive predictive value of 100% in both the groups, negative predictive value of 67% in group A and 79% in group B. Histopathological examination demonstrated a single gland disease in 8 (88.9%) patients in group A and a multi gland disease in 1 (11.1%), in group B single gland disease was found in 218 (92.8%) patients and multi gland disease in 17 (7.2%). Unsuccessful surgery with persistent or recurrent hyperparathyroidism occurred in 1 (11.1%) patient in group A and 4 (1.7%) in group B.
Primary hyperparathyroidism with normal PTH is rare but physicians should be aware of this possibility in patients with hypercalcaemia. Patients with normal PTH levels are younger and more frequently symptomatic. Intraoperative PTH testing plays an important role in the operative management even in such patients.
原发性甲状旁腺功能亢进是一种常见的内分泌疾病。甲状旁腺激素（PTH）水平正常的高钙血症非常罕见，可能导致诊断困难。文献中相关研究极少，且样本数量有限。本研究的目的是确定PTH正常的原发性甲状旁腺功能亢进的实际发病率和特征，并评估术中PTH检测对这些患者是否有用。
我们对2002年1月至2016年12月期间接受甲状旁腺切除术治疗原发性甲状旁腺功能亢进的314例患者进行了回顾性分析。根据术前生化检查结果将患者分为两组：A组包括血清PTH正常的患者，B组包括血清PTH升高的患者。
A组纳入9例患者（3.7%），B组纳入235例患者。A组患者更年轻（51.5±12.9岁 vs 59.6±12.5岁）；两组术前血清钙水平及甲状腺疾病并存发生率相似。A组有症状的患者更常见（77.8% vs 39.1%；p = 0.048）。术前定位研究和手术方式方面无显著差异。术中PTH测定显示，A组的敏感性为86%，B组为97%；两组的特异性和阳性预测值均为100%，A组的阴性预测值为67%，B组为79%。组织病理学检查显示，A组8例（88.9%）患者为单腺体疾病，1例（11.1%）为多腺体疾病；B组218例（92.8%）患者为单腺体疾病，17例（7.2%）为多腺体疾病。A组1例（11.1%）患者手术失败，出现持续性或复发性甲状旁腺功能亢进，B组4例（1.7%）。
PTH正常的原发性甲状旁腺功能亢进很少见，但医生应警惕高钙血症患者存在这种可能性。PTH水平正常的患者更年轻，且更常出现症状。即使对于此类患者，术中PTH检测在手术管理中也起着重要作用。
