Brescia Marília D'Elboux Guimarães, Rodrigues Karine Candido, d'Alessandro André Fernandes, Alves Filho Wellington, van der Plas Willemijn Y, Kruijff Schelto, Arap Sergio Samir, Toledo Sergio Pereira de Almeida, Montenegro Fábio Luiz de Menezes, Lourenço Delmar Muniz
Endocrine Genetics Unit (LIM-25), Endocrinology Division, University of São Paulo School of Medicine (FMUSP), Faculdade de Medicina da Universidade de São Paulo (FMUSP), Hospital das Clinicas (HCFMUSP), São Paulo, São Paulo, Brazil.
Parathyroid Unit - LIM-28, Laboratório de Cirurgia de Cabeça e Pescoço, Division of Head and Neck Surgery, Department of Surgery, Hospital das Clinicas (HCFMUSP), University of São Paulo School of Medicine (FMUSP), Faculdade de Medicina, Universidade de São Paulo, São Paulo, São Paulo, Brazil.
Endocr Connect. 2022 Jun 23;11(6). doi: 10.1530/EC-22-0021. Print 2022 Jun 1.
Potential influences of parathyroidectomy (PTx) on the quality of life (QoL) in multiple endocrine neoplasia type 1-related primary hyperparathyroidism (HPT/MEN1) are unknown.
Short Form 36 Health Survey Questionnaire was prospectively applied to 30 HPT/MEN1 patients submitted to PTx (20, subtotal; 10, total with autograft) before, 6 and 12 months after surgery. Parameters that were analyzed included QoL, age, HPT-related symptoms, general pain, comorbidities, biochemical/hormonal response, PTx type and parathyroid volume.
Asymptomatic patients were younger (30 vs 38 years; P = 0.04) and presented higher QoL scores than symptomatic ones: Physical Component Summary score (PCS) 92.5 vs 61.2, P = 0.0051; Mental Component Summary score (MCS) 82.0 vs 56.0, P = 0.04. In both groups, QoL remained stable 1 year after PTx, independently of the number of comorbidities. Preoperative general pain was negatively correlated with PCS (r = -0.60, P = 0.0004) and MCS (r = -0.57, P = 0.0009). Also, moderate/intense pain was progressively (6/12 months) more frequent in cases developing hypoparathyroidism. The PTx type and hypoparathyroidism did not affect the QoL at 12 months although remnant parathyroid tissue volume did have a positive correlation (P = 0.0490; r = 0.3625) to PCS 12 months after surgery. Patients with one to two comorbidities had as pre-PTx PCS (P = 0.0015) as 12 months and post-PTx PCS (P = 0.0031) and MCS (P = 0.0365) better than patients with three to four comorbidities.
A variable QoL profile was underscored in HPT/MEN1 reflecting multiple factors associated with this complex disorder as comorbidities, advanced age at PTx and presence of preoperative symptoms or of general pain perception. Our data encourage the early indication of PTx in HPT/MEN1 by providing known metabolic benefits to target organs and avoiding potential negative impact on QoL.
甲状旁腺切除术（PTx）对1型多发性内分泌腺瘤病相关原发性甲状旁腺功能亢进症（HPT/MEN1）患者生活质量（QoL）的潜在影响尚不清楚。
前瞻性地将简短健康调查问卷36项应用于30例接受PTx的HPT/MEN1患者（20例次全切除；10例次全切除并自体移植），分别在手术前、术后6个月和12个月进行调查。分析的参数包括生活质量、年龄、HPT相关症状、全身疼痛、合并症、生化/激素反应、PTx类型和甲状旁腺体积。
无症状患者较年轻（30岁对38岁；P = 0.04），且生活质量评分高于有症状患者：生理健康评分（PCS）92.5对61.2，P = 0.0051；心理健康评分（MCS）82.0对56.0，P = 0.04。在两组中，PTx术后1年生活质量保持稳定，与合并症数量无关。术前全身疼痛与PCS呈负相关（r = -0.60，P = 0.0004），与MCS呈负相关（r = -0.57，P = 0.0009）。此外，发生甲状旁腺功能减退的患者中，中度/重度疼痛在术后6/12个月时逐渐更频繁。PTx类型和甲状旁腺功能减退在术后12个月时不影响生活质量，尽管残余甲状旁腺组织体积与术后12个月时的PCS呈正相关（P = 0.0490；r = 0.3625）。有一到两种合并症的患者术前PCS（P = 0.0015）、术后12个月PCS（P = 0.0031）和MCS（P = 0.0365）均优于有三到四种合并症的患者。
HPT/MEN1患者的生活质量情况各异，反映出与这种复杂疾病相关的多种因素，如合并症、PTx时的高龄以及术前症状或全身疼痛感知的存在。我们的数据通过为靶器官提供已知的代谢益处并避免对生活质量的潜在负面影响，鼓励在HPT/MEN1中尽早进行PTx。
