Cormier Catherine, Koumakis Eugénie
Service de Rhumatologie Hôpital Cochin, APHP, Université Paris Descartes, Centre de Référence des Maladies du Métabolisme du Calcium et du Phosphate, 27, Rue du Faubourg St Jacques, 75679 Paris Cedex 14, France.
Service de Rhumatologie Hôpital Cochin, APHP, Université Paris Descartes, Centre de Référence des Maladies du Métabolisme du Calcium et du Phosphate, 27, Rue du Faubourg St Jacques, 75679 Paris Cedex 14, France.
Joint Bone Spine. 2022 Jan;89(1):105129. doi: 10.1016/j.jbspin.2021.105129. Epub 2021 Jan 20.
Primary hyperparathyroidism (PHPT) is a disease caused by excessive and inappropriate secretion of parathyroid hormone resulting in hypercalcemia. It is usually diagnosed incidentally in case of hypercalcemia, osteoporosis or, more rarely, renal involvement such as lithiasis. The clinical presentation reflects hypercalcemia and involves several organs, mainly the cardiovascular system, bone, and kidneys. However, most patients with PHPT are asymptomatic. The diagnosis is biological, obvious when serum calcium and parathyroid hormone levels are high, but difficult when one of these two values is normal. The diagnosis of normocalcemic PHPT is possible only after ruling out all causes of secondary hyperparathyroidism. Parathyroid imaging does not contribute to the positive diagnosis but guides surgery and rules out an associated thyroid abnormality. Parathyroid surgery is the gold standard treatment. Parathyroid surgery is indicated in the presence or risk of complications, and it is the only treatment that prevents fractures. Pharmaceutical treatments have only limited effects on complications and are limited to cases where surgery is contraindicated. After parathyroid surgery, the use of bisphosphonates must be avoided as they seem to interfere with the parathyroidectomy's fracture-preventing effects. In the absence of surgical indication, medical monitoring of patients includes assessment of laboratory values, bone density, and renal function.
原发性甲状旁腺功能亢进症（PHPT）是一种由于甲状旁腺激素分泌过多且不适当导致高钙血症的疾病。它通常在高钙血症、骨质疏松症或更罕见的肾脏受累（如结石）情况下偶然被诊断出来。临床表现反映高钙血症，累及多个器官，主要是心血管系统、骨骼和肾脏。然而，大多数PHPT患者没有症状。诊断依靠生物学指标，当血清钙和甲状旁腺激素水平升高时诊断明显，但当这两个值之一正常时诊断困难。仅在排除所有继发性甲状旁腺功能亢进的原因后，才有可能诊断为血钙正常的PHPT。甲状旁腺成像对阳性诊断没有帮助，但可指导手术并排除相关的甲状腺异常。甲状旁腺手术是金标准治疗方法。在存在并发症或有并发症风险时应进行甲状旁腺手术，它是预防骨折的唯一治疗方法。药物治疗对并发症的影响有限，仅限于手术禁忌的情况。甲状旁腺手术后，必须避免使用双膦酸盐，因为它们似乎会干扰甲状旁腺切除术预防骨折的效果。在没有手术指征的情况下，对患者的医学监测包括评估实验室值、骨密度和肾功能。
