Shaker Joseph L, Wermers Robert A
Department of Medicine and Division of Endocrinology and Molecular Medicine, Medical College of Wisconsin, Milwaukee, WI, USA.
Department of Medicine and Division of Endocrinology, Diabetes, Metabolism and Nutrition, Mayo Clinic, Rochester, MN, USA.
J Endocr Soc. 2023 Jan 26;7(4):bvad013. doi: 10.1210/jendso/bvad013. eCollection 2023 Feb 9.
Primary hyperparathyroidism (PHPT) is classically characterized by hypercalcemia with elevated or inappropriately normal parathyroid hormone (PTH) levels. Elevated PTH levels in the presence of normal calcium levels are not infrequently found during the evaluation of metabolic bone disorders or kidney stone disease. This can be caused by secondary hyperparathyroidism (SHPT) or normocalcemic primary hyperparathyroidism (NPHPT). NPHPT is due to autonomous parathyroid function whereas SHPT is caused by a physiologic stimulation to PTH secretion. Many medical conditions and medications can contribute to SHPT, and differentiation between SHPT and NPHPT may be difficult. Cases are presented to illustrate examples. In this paper, we review the distinction between SHPT and NPHPT as well as end organ effects of NPHPT and outcomes of surgery in NPHPT. We suggest that the diagnosis of NPHPT be made only after careful exclusion of causes of SHPT and consideration of medications that can increase PTH secretion. Further, we advise a conservative approach to surgery in NPHPT.
原发性甲状旁腺功能亢进症（PHPT）的典型特征是高钙血症伴甲状旁腺激素（PTH）水平升高或正常但不适当。在评估代谢性骨病或肾结石疾病时，经常会发现血钙水平正常但PTH水平升高的情况。这可能是由继发性甲状旁腺功能亢进症（SHPT）或血钙正常的原发性甲状旁腺功能亢进症（NPHPT）引起的。NPHPT是由于甲状旁腺自主功能所致，而SHPT是由对PTH分泌的生理刺激引起的。许多医学状况和药物都可能导致SHPT，区分SHPT和NPHPT可能很困难。本文通过病例举例进行说明。我们回顾了SHPT和NPHPT之间的区别，以及NPHPT的终末器官效应和NPHPT手术的结果。我们建议仅在仔细排除SHPT的病因并考虑可能增加PTH分泌的药物后，才能做出NPHPT的诊断。此外，我们建议对NPHPT采取保守的手术方法。
