Rude R K
Division of Endocrinology/Diabetes/Hypertension, University of Southern California, Los Angeles, USA.
Otolaryngol Clin North Am. 1996 Aug;29(4):663-79.
Primary hyperparathyroidism is the most prevalent cause of hypercalcemia. Although renal stone disease and osteitis fibrosis were prominent complications of this disorder in the past, the advent of biochemical screening has resulted in earlier detection. This has changed the clinical presentation of primary hyperparathyroidism, so that as many as 80% of patients do not have any sign or symptom that can be attributed solely to the disease. Improvement in assays for PTH has allowed for accurate bio-chemical diagnosis in over 90% of cases. Neck exploration is the treatment of choice for any patient who presents with signs, symptoms, or complications of hypercalcemia or hyperparathyroidism. Medical therapy is indicated in patients who either cannot undergo surgery because of medical contraindication, failed prior neck surgery, unresectable parathyroid carcinoma or simply refuse surgery. Medical therapy is not optimal, although sex steroid replacement therapy in the postmenopausal woman has met with some success. Calcitonin, phosphate, and bisphosphonates may be used, but their long-term efficacy is not clear. Recent studies have suggested that a large proportion of patients with asymptomatic primary hyperparathyroidism do not demonstrate progression of disease in terms of renal dysfunction, bone disease, or biochemical changes in calcium or PTH. Guidelines have been established for medical follow-up of such patients. If any such patient develops signs or symptoms during medical follow-up, surgery is then indicated.
原发性甲状旁腺功能亢进是高钙血症最常见的病因。尽管肾结石病和纤维性骨炎在过去是该疾病的主要并发症，但生化筛查的出现使得疾病能够更早被发现。这改变了原发性甲状旁腺功能亢进的临床表现，以至于多达80%的患者没有任何仅可归因于该疾病的体征或症状。甲状旁腺激素检测方法的改进使得超过90%的病例能够得到准确的生化诊断。对于任何出现高钙血症或甲状旁腺功能亢进体征、症状或并发症的患者，颈部探查是首选的治疗方法。对于因医学禁忌证无法接受手术、既往颈部手术失败、无法切除的甲状旁腺癌或仅仅拒绝手术的患者，可采用内科治疗。内科治疗并非最佳选择，尽管绝经后女性的性激素替代疗法取得了一些成功。可使用降钙素、磷酸盐和双膦酸盐，但它们的长期疗效尚不清楚。最近的研究表明，很大一部分无症状原发性甲状旁腺功能亢进患者在肾功能、骨病或钙或甲状旁腺激素的生化变化方面并未表现出疾病进展。已制定了对此类患者进行医学随访的指南。如果任何此类患者在医学随访期间出现体征或症状，则需进行手术治疗。
