Department of Diabetes and Endocrinology, University of KwaZulu-Natal, Durban, South Africa.
BMC Endocr Disord. 2024 Apr 25;24(1):53. doi: 10.1186/s12902-024-01583-8.
There has been a notable shift towards the diagnosis of less severe and asymptomatic primary hyperparathyroidism (PHPT) in developed countries. However, there is a paucity of recent data from sub-Saharan Africa (SSA), and also, no reported data from SSA on the utility of intra-operative parathyroid hormone (IO-PTH) monitoring. In an earlier study from Inkosi Albert Luthuli Central Hospital (IALCH), Durban, South Africa (2003-2009), majority of patients (92.9%) had symptomatic disease. The aim of this study was to evaluate the clinical profile and management outcomes of patients presenting with PHPT at IALCH.
A retrospective chart review of patients with PHPT attending the Endocrinology clinic at IALCH between July 2009 and December 2021. Clinical presentation, laboratory results, radiologic findings, surgical notes and histology were recorded.
Analysis included 110 patients (87% female) with PHPT. Median age at presentation was 57 (44; 67.5) years. Symptomatic disease was present in 62.7% (n:69); 20.9% (n:23) had a history of nephrolithiasis and 7.3% (n:8) presented with previous fragility fractures. Mean serum calcium was 2.87 ± 0.34 mmol/l; median serum-PTH was 23.3 (15.59; 45.38) pmol/l, alkaline phosphatase 117.5 (89; 145.5) U/l and 25-hydroxyvitamin-D 42.9 (33.26; 62.92) nmol/l. Sestamibi scan (n:106 patients) identified an adenoma in 83.02%. Parathyroidectomy was performed on 84 patients with a cure rate of 95.2%. Reasons for conservative management (n:26) included: no current surgical indication (n:7), refusal (n:5) or deferral of surgery (n:5), loss to follow-up (n:5) and assessed as high anaesthetic risk (n:4). IO-PTH measurements performed on 28 patients indicated surgical success in 100%, based on Miami criteria. Histology confirmed adenoma in 88.1%, hyperplasia in 7.1% and carcinoma in 4.8%. Post-operative hypocalcaemia developed in 30 patients (35.7%), of whom, 14 developed hungry bone syndrome (HBS). In multivariate analysis, significant risk factors associated with HBS included male sex (OR 7.01; 95% CI 1.28, 38.39; p 0.025) and elevated pre-operative PTH (OR 1.01; 95% CI 1.00, 1.02; p 0.008).
The proportion of asymptomatic PHPT has increased at this centre over the past decade but symptomatic disease remains the dominant presentation. Parathyroidectomy is curative in the majority of patients. IO-PTH monitoring is valuable in ensuring successful surgery.
在发达国家，原发性甲状旁腺功能亢进症（PHPT）的诊断已明显向较轻和无症状的方向转变。然而，来自撒哈拉以南非洲（SSA）的最新数据很少，也没有来自 SSA 的关于术中甲状旁腺激素（IO-PTH）监测的报告数据。在南非德班因科西·阿尔伯特·卢图利中央医院（IALCH）的一项早期研究中（2003-2009 年），大多数患者（92.9%）患有有症状的疾病。本研究旨在评估 IALCH 就诊的 PHPT 患者的临床特征和治疗结果。
对 2009 年 7 月至 2021 年 12 月期间在 IALCH 内分泌科就诊的 PHPT 患者进行回顾性图表审查。记录临床症状、实验室结果、影像学发现、手术记录和组织学检查。
分析包括 110 例（87%为女性）PHPT 患者。发病时的中位年龄为 57（44；67.5）岁。有症状的疾病占 62.7%（n：69）；20.9%（n：23）有肾结石病史，7.3%（n：8）有既往脆性骨折史。血清钙平均值为 2.87±0.34mmol/L；中位血清-PTH 为 23.3（15.59；45.38）pmol/L，碱性磷酸酶为 117.5（89；145.5）U/L，25-羟维生素 D 为 42.9（33.26；62.92）nmol/L。锝-99m 亚甲基二膦酸盐扫描（n=106 例患者）在 83.02%的患者中发现了腺瘤。84 例患者进行了甲状旁腺切除术，治愈率为 95.2%。（n=26）行保守治疗的原因包括：当前无手术指征（n=7）、拒绝（n=5）或推迟手术（n=5）、失访（n=5）和评估为高麻醉风险（n=4）。对 28 例患者进行 IO-PTH 测量，根据迈阿密标准，手术成功率为 100%。组织学检查证实 88.1%为腺瘤，7.1%为增生，4.8%为癌。30 例患者（35.7%）发生术后低钙血症，其中 14 例发生饥饿骨综合征（HBS）。多因素分析显示，HBS 的显著危险因素包括男性（OR 7.01；95%CI 1.28，38.39；p 0.025）和术前 PTH 升高（OR 1.01；95%CI 1.00，1.02；p 0.008）。
在过去十年中，该中心无症状 PHPT 的比例有所增加，但有症状的疾病仍然是主要表现。甲状旁腺切除术在大多数患者中是治愈性的。IO-PTH 监测对于确保手术成功是有价值的。
