Ljunghall S, Källsen R, Backman U, Danielson B G, Grimelius L, Johansson H, Thorén L, Werner I
Acta Chir Scand. 1980;146(3):161-9.
Among 52 patients with recurrent renal calcium stones submitted for neck exploration 12 had adenomas, 23 hyperplasia and only 17 histologically normal parathyroid glands. These patients were selected for surgery despite a normal mean value of the total serum calcium concentration because they had, in most cases, indirect evidence of parathyroid hyperfunction such as intermittent hypercalcaemia (in 25 of the patients), hypercalciuria or a pathological response to calcium infusion. It is suggested that the patients with adenomas suffered from primary hyperparathyroidism (HPT), which however did not cause persisting hypercalcaemia. It seems likely that parathyroid hyperplasia either was a mild or an early form of primary HPT or secondary to increased calcium losses. In this study, no single laboratory feature could clearly separate the different groups. None of the patients with adenomas formed any new stone during follow-up (2-7 years) and also 40% of those with hyperplasia appeared to experience benefit from surgery. This benefit was more common in those with occasionally raised serum calcium values. In cases with borderline hypercalcaemia HPT is common and is cured by parathyroidectomy. However, in clinical practice the differential diagnosis may be difficult. In cases without firm evidence of HPT a conservative approach is favoured. Thiazides appear to reduce the stone recurrence rate in most euparathyroid patients and will probably help to unmask borderline HPT in recurrent renal stone formers.
在52例因复发性肾钙结石而接受颈部探查的患者中，12例有腺瘤，23例有增生，只有17例甲状旁腺组织学正常。这些患者尽管血清总钙浓度平均值正常，但仍被选作手术，因为在大多数情况下，他们有甲状旁腺功能亢进的间接证据，如间歇性高钙血症（25例患者）、高钙尿症或对钙输注的病理性反应。提示腺瘤患者患有原发性甲状旁腺功能亢进（HPT），但未导致持续性高钙血症。甲状旁腺增生似乎要么是原发性HPT的轻度或早期形式，要么是钙丢失增加继发的。在本研究中，没有单一的实验室特征能够清楚地区分不同的组。腺瘤患者在随访（2至7年）期间均未形成任何新结石，增生患者中也有40%似乎从手术中获益。这种获益在血清钙偶尔升高的患者中更常见。在血钙临界升高的病例中，HPT很常见，甲状旁腺切除术可治愈。然而，在临床实践中，鉴别诊断可能很困难。在没有HPT确凿证据的病例中，倾向于采取保守方法。噻嗪类药物似乎能降低大多数甲状旁腺功能正常患者的结石复发率，可能有助于揭示复发性肾结石患者的临界HPT。
