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原发性甲状旁腺功能亢进的双侧探查：二十多年来的双腺瘤分布和生化模式。

Bilateral exploration in primary hyperparathyroidism: Double adenoma distribution and biochemical patterns over two decades.

机构信息

Department of Endocrine Surgery, Endocrinology and Metabolism Institute, Cleveland Clinic, OH, USA.

Department of Surgery, George Washington University, Washington, DC, USA.

出版信息

Am J Surg. 2024 Jul;233:61-64. doi: 10.1016/j.amjsurg.2024.02.008. Epub 2024 Feb 9.

DOI:10.1016/j.amjsurg.2024.02.008

PMID:38365553

Abstract

BACKGROUND

We investigated if anatomic patterns of abnormal parathyroid glands have ch anged for primary hyperparathyroidism (pHPT) as atypical biochemical presentation (normohormonal and normocalcemic) has increased.

METHODS

Retrospective review of patients with pHPT who underwent routine bilateral neck exploration.

RESULTS

2762 patients were included. The "late" cohort (2014-2020) exhibited lower preoperative calcium (10.8 vs 11.1 mg/dL; P = 0.001) and PTH levels (101 vs. 146 pg/mL; P = 0.001) compared to the "early" cohort (2000-2006). Patients with atypical biochemical profiles increased from 25.5% to 31.3% (P < 0.001). The prevalence of single adenoma (SA) decreased (66.1% vs 58.9%, P = 0.02) while the proportion of double adenoma (DA) increased (17.3% vs. 22.6%, P < 0.01). Upper parathyroid adenoma(s) remained the most common finding for SA and DA in both time points.

CONCLUSIONS

Despite changes in patient characteristics, single upper adenoma and bilateral double upper adenomas remain the most common findings for patients with pHPT.

摘要

背景

我们研究了甲状旁腺功能亢进症（pHPT）的解剖学模式是否发生了变化，因为不典型生化表现（正常激素和正常钙水平）的病例增多。

方法

回顾性分析接受常规双侧颈部探查的 pHPT 患者。

结果

共纳入 2762 例患者。与“早期”队列（2000-2006 年）相比，“晚期”队列（2014-2020 年）的术前血钙（10.8 对 11.1mg/dL；P=0.001）和 PTH 水平（101 对 146pg/mL；P=0.001）更低。不典型生化特征患者的比例从 25.5%增加到 31.3%（P<0.001）。单发腺瘤（SA）的患病率下降（66.1%对 58.9%，P=0.02），而双发腺瘤（DA）的比例增加（17.3%对 22.6%，P<0.01）。在上、下甲状旁腺中，上甲状旁腺腺瘤（SA 和 DA）仍然是最常见的发现。