Department of Breast, Endocrine Tumours and Sarcoma, Karolinska University Hospital, Stockholm, Sweden.
Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.
Br J Surg. 2019 Dec;106(13):1810-1818. doi: 10.1002/bjs.11319. Epub 2019 Oct 9.
Primary hyperparathyroidism is often associated with non-disease-specific symptoms. The aim of this study was to evaluate whether normalization of hypercalcaemia with short-term medical treatment can be used to predict the effects of parathyroidectomy and guide in surgical decision-making.
This observational study included patients who received calcimimetic treatment for 4 weeks before parathyroidectomy (30-60 mg daily). A panel of tests was used to assess various aspects of quality of life (European Organisation and Treatment of Cancer QLQ-C30 core questionnaire, Hospital Anxiety and Depression Scale and Positive State of Mind questionnaire), cognitive function (Montreal Cognitive Assessment) and muscle strength (timed-stands test). The tests were carried out at baseline, after 4 weeks of calcimimetic treatment, and at 6 weeks and 6 months after parathyroidectomy. The predictive values of changes during calcimimetic treatment were determined for each test.
The study included 110 patients of median age 62 years (91 women). Calcimimetic treatment resulted in normalization of calcium levels and improvements in quality-of-life parameters. The time spent on the timed-stands test was significantly shortened. Eleven of 38 participants with a baseline Montreal Cognitive Assessment score below 26, indicating mild cognitive impairment, reached scores of at least 26 during treatment with calcimimetic. Improvements during treatment with calcimimetic correlated well with postoperative outcomes (positive predictive values 74-96 per cent).
The method described in this study may be used to aid surgical decision-making for patients with primary hyperparathyroidism and non-disease-specific symptoms by predicting the effects of normalization of hypercalcaemia.
原发性甲状旁腺功能亢进症常伴有非特异性疾病症状。本研究旨在评估短期药物治疗使血钙正常化是否可用于预测甲状旁腺切除术的效果，并指导手术决策。
本观察性研究纳入了在甲状旁腺切除术（每日 30-60mg）前接受钙敏感受体激动剂治疗 4 周的患者。采用一系列测试评估生活质量（欧洲癌症研究与治疗组织 QLQ-C30 核心问卷、医院焦虑抑郁量表和积极心态问卷）、认知功能（蒙特利尔认知评估）和肌肉力量（定时站立测试）的各个方面。在基线、钙敏感受体激动剂治疗 4 周后以及甲状旁腺切除术后 6 周和 6 个月进行测试。确定了钙敏感受体激动剂治疗期间变化的预测值。
研究纳入了中位年龄为 62 岁（91 名女性）的 110 名患者。钙敏感受体激动剂治疗使钙水平正常化，并改善了生活质量参数。定时站立测试所花费的时间明显缩短。38 名基线蒙特利尔认知评估得分低于 26（表示轻度认知障碍）的参与者中，有 11 名在钙敏感受体激动剂治疗期间得分至少达到 26。钙敏感受体激动剂治疗期间的改善与术后结果密切相关（阳性预测值为 74-96%）。
本研究中描述的方法可通过预测血钙正常化的效果来辅助有非特异性疾病症状的原发性甲状旁腺功能亢进症患者的手术决策。
