Department of Surgery, St. Paul's Hospital & University of British Columbia, C303-1081 Burrard St, Vancouver, British Columbia, V6Z 1Y6, Canada.
Am J Surg. 2023 Aug;226(2):186-196. doi: 10.1016/j.amjsurg.2023.04.004. Epub 2023 Apr 19.
We aim to evaluate the body of evidence reporting on normohormonal primary hyperparathyroidism (NHpHPT) patients to help guide their diagnosis, characterization and treatment.
Normohormonal primary hyperparathyroidism is a term used to describe patients with a normal PTH and elevated calcium levels. There is limited understanding regarding the presentation and appropriate management of these patients.
A systematic review was conducted: abstract and full-text screening were independently conducted by 2 investigators. Odds ratios (OR), standard mean differences (SMD) and 95% confidence intervals were calculated.
Twenty-two studies were identified. Patients with NHpHPT were more likely to present with lower PTH (p < 0.00001) and calcium (p < 0.00001) levels. Intraoperatively, the NHpHPT group was 1.8 times more likely to undergo bilateral neck exploration (BNE) and harbor multigland disease. The rates of surgical cure were 93% in the NHpHPT and 96% in the pHPT groups (p = 0.0003).
Symptomatic patients with NHpHPT benefit from parathyroidectomy with prolonged intraoperative PTH monitoring, and a low threshold for conversion to BNE.
我们旨在评估报告正常甲状旁腺功能亢进症（NHpHPT）患者的证据，以帮助指导其诊断、特征描述和治疗。
正常甲状旁腺功能亢进症是用于描述甲状旁腺激素正常但血钙升高的患者的术语。对于这些患者的表现和适当的治疗，了解有限。
进行了系统回顾：两名调查员独立进行了摘要和全文筛选。计算了比值比（OR）、标准均数差（SMD）和 95%置信区间。
确定了 22 项研究。NHpHPT 患者更有可能表现出较低的甲状旁腺激素（p < 0.00001）和钙水平（p < 0.00001）。术中，NHpHPT 组行双侧颈部探查（BNE）和多灶性疾病的可能性增加了 1.8 倍。NHpHPT 组的手术治愈率为 93%，pHPT 组为 96%（p = 0.0003）。
有症状的 NHpHPT 患者受益于甲状旁腺切除术，术中甲状旁腺激素监测时间延长，双侧颈部探查的阈值较低。
