Irvin G L, Newell D J, Morgan S D
Department of Surgery, University of Miami School of Medicine, FL 33101.
Surgery. 1987 Dec;102(6):898-902.
Parathyroidectomy is usually followed by a decrease in serum calcium, a lessening of symptoms, and a normocalcemic state that continues for years. Evaluation of parathyroid gland function after parathyroidectomy over a protracted period showed a continued hypersecretory state in many normocalcemic patients and is reported here for the first time. Patients identified with parathyroid hyperplasia (more than one gland excised) and patients who later developed mild renal failure were excluded. Seventy-seven patients undergoing parathyroidectomy with only one enlarged gland removed and the other normal-sized glands viewed or examined by biopsy were followed up from 5 to 16 years. Two patients developed recurrent hypercalcemia at 4 and 9 years after surgery. Seventy-five patients are considered "cured" and have normal serum calcium values. However, 28 (37%) of these normocalcemic patients have persistent elevations of parathyroid hormone. This increased parathyroid gland function suggests a continuing stimulation of the remaining glands. The rarity of clinical recurrence may be related to effective adaptations that prevent overt hypercalcemia. Many parathyroid adenomas appear to represent nonneoplastic disease.
甲状旁腺切除术后通常会出现血清钙降低、症状减轻以及持续数年的血钙正常状态。本文首次报道了对甲状旁腺切除术后长期甲状旁腺功能的评估，结果显示许多血钙正常的患者仍处于持续的高分泌状态。排除了被诊断为甲状旁腺增生（切除多个腺体）的患者以及后来出现轻度肾衰竭的患者。对77例仅切除一个肿大腺体且对其他正常大小腺体进行观察或活检的甲状旁腺切除术患者进行了5至16年的随访。两名患者在术后4年和9年出现复发性高钙血症。75例患者被认为“治愈”，血清钙值正常。然而，这些血钙正常的患者中有28例（37%）甲状旁腺激素持续升高。甲状旁腺功能的这种增强表明剩余腺体受到持续刺激。临床复发的罕见性可能与预防明显高钙血症的有效适应性有关。许多甲状旁腺腺瘤似乎代表非肿瘤性疾病。
