Kochman Magdalena
Department of Endocrinology, Centre of Postgraduate Medical Education, Bielanski Hospital, Warsaw, Poland.
Reumatologia. 2023;61(4):256-263. doi: 10.5114/reum/170705. Epub 2023 Aug 31.
Primary hyperparathyroidism (PHPT) is a frequent endocrine disease which mainly affects the skeletal system and kidney. Some of its signs and symptoms are similar to those seen in rheumatic diseases such as rheumatoid arthritis, Sjögren's disease, fibromyalgia, polymyalgia rheumatica, gout or systemic lupus erythematosus. Coexistence of primary hyperparathyroidism with those pathologies potentiate their effects on muscles, bones and joints, increasing the risk of complications such as osteoporosis and fractures. Therefore, rheumatologists should be familiar with symptoms and diagnostic criteria of PHPT and consider it in the differential diagnosis of rheumatic diseases. In 2022 the Fifth International Workshop guidelines on the PHPT evaluation and management were published. They are based on a profound analysis of advances in research concerning multiple fields, that include genetics, outcomes and new imaging modalities of PHPT. They have led to revision of previous renal indications for parathyroidectomy in PHPT. There is also more evidence for the other recommendations regarding evaluation of the disease. This article summarizes the most relevant elements of these recommendations and refers them to Polish realities. I focus on the symptoms of primary hyperparathyroidism and its diagnosis as I consider these areas to be the most important for non-endocrinologists.
原发性甲状旁腺功能亢进症（PHPT）是一种常见的内分泌疾病，主要影响骨骼系统和肾脏。其一些体征和症状与类风湿性关节炎、干燥综合征、纤维肌痛、风湿性多肌痛、痛风或系统性红斑狼疮等风湿性疾病相似。原发性甲状旁腺功能亢进症与这些疾病共存会增强它们对肌肉、骨骼和关节的影响，增加骨质疏松和骨折等并发症的风险。因此，风湿病学家应熟悉原发性甲状旁腺功能亢进症的症状和诊断标准，并在风湿性疾病的鉴别诊断中予以考虑。2022年发布了关于原发性甲状旁腺功能亢进症评估和管理的第五届国际研讨会指南。这些指南基于对多个领域研究进展的深入分析，包括原发性甲状旁腺功能亢进症的遗传学、治疗结果和新的成像方式。它们导致了对原发性甲状旁腺功能亢进症甲状旁腺切除术先前肾脏指征的修订。关于该疾病评估的其他建议也有了更多证据。本文总结了这些建议中最相关的内容，并将其与波兰的实际情况联系起来。由于我认为这些领域对非内分泌科医生最为重要，所以我重点关注原发性甲状旁腺功能亢进症的症状及其诊断。
