Alameer Ehab, Omar Mahmoud, Hoof Marcus, Shalaby Hosam, Abdelgawad Mohamed, Zora Ghassan, Shama Mohamed, Kandil Emad
Department of Surgery, 5783Tulane University School of Medicine, New Orleans, LA, USA.
Department of Surgery, Faculty of Medicine, 123285Jazan University, Jazan, Saudi Arabia.
Am Surg. 2022 May;88(5):873-879. doi: 10.1177/00031348211048844. Epub 2021 Nov 14.
Normocalcemic primary hyperparathyroidism (NCpHPT) and normohormonal primary hyperparathyroidism (NHpHPT) are recently recognized variants of primary hyperparathyroidism. Current guidelines for the management hyperparathyroidism recognize NCpHPT as one of the areas that are recommended for more research due to limited available data.
A retrospective review of patients who had parathyroidectomy between 2014 and 2019. We excluded patients with multiple endocrine neoplasia syndromes and secondary and tertiary hyperparathyroidism. Included patients were classified based on the biochemical profile into classic or normocalcemic hyperparathyroidism group. Collected data included demographics, preoperative localizing imaging, intraoperative parathyroid hormone levels, and postoperative cure rates.
261 patients were included: 160 patients in the classic and 101 patients in the normocalcemic group. Patients in the normocalcemic group had significantly more negative sestamibi scans (n = 58 [8.2%] vs 78 [51.3%], = <.01), smaller parathyroid glands (mean weight 436.0 ± 593.0 vs 742.4 ± 1109.0 mg, = .02), higher parathyroid hyperplasia rates (n = 51 [50.5%] vs 69 [43.1%]), and significantly higher intraoperative parathyroid hormone at 10 minutes (78.1 ± 194.6 vs 43.9 ± 62.4 1, = .04). Positive predictive value of both intraoperative parathyroid hormone and cure rate was lower in the normocalcemic group (84.2% vs 95.7%) and (80.5% vs 95%), respectively.
Normocalcemic hyperparathyroidism is a challenging disease. Surgeons should be aware of the lower cure rate in this group, interpret intraoperative parathyroid hormone with caution, and have a lower threshold for bilateral neck exploration and 4 glands visualization.
血钙正常的原发性甲状旁腺功能亢进症（NCpHPT）和激素水平正常的原发性甲状旁腺功能亢进症（NHpHPT）是最近才被认识的原发性甲状旁腺功能亢进症的变体。目前的甲状旁腺功能亢进症管理指南将NCpHPT视为因可用数据有限而建议进行更多研究的领域之一。
对2014年至2019年间接受甲状旁腺切除术的患者进行回顾性研究。我们排除了患有多发性内分泌肿瘤综合征以及继发性和三发性甲状旁腺功能亢进症的患者。纳入的患者根据生化特征分为经典型或血钙正常型甲状旁腺功能亢进症组。收集的数据包括人口统计学资料、术前定位成像、术中甲状旁腺激素水平以及术后治愈率。
共纳入261例患者：经典型组160例，血钙正常组101例。血钙正常组患者的锝[99mTc]甲氧基异丁基异腈扫描阴性结果显著更多（n = 58 [8.2%] 对78 [51.3%]，P <.01），甲状旁腺更小（平均重量436.0 ± 593.0对742.4 ± 1109.0毫克，P = .02），甲状旁腺增生率更高（n = 51 [50.5%] 对69 [43.1%]），并且在10分钟时术中甲状旁腺激素水平显著更高（78.1 ± 194.6对43.9 ± 62.4 1，P = .04）。血钙正常组术中甲状旁腺激素和治愈率的阳性预测值分别较低（84.2%对95.7%）和（80.5%对95%）。
血钙正常的甲状旁腺功能亢进症是一种具有挑战性的疾病。外科医生应意识到该组的治愈率较低，谨慎解读术中甲状旁腺激素，并对双侧颈部探查和四个腺体可视化的阈值较低。
