ISSN: 1301-2193 E-ISSN: 1308-9846
  • Turkish Journal of
    Endocrinology and Metabolism
ORIGINAL ARTICLE

The Patients with Primary Hyperparathyroidism: Evaluation of the Last Two Years
Primer Hiperparatiroidili Hastalarımız: Son İki Yılın Değerlendirmesi
Doi: 10.4274/Tjem.2020 - Makale Dili: EN
ABSTRACT

Purpose: We aimed to report demographic and clinical characteristics of patients with primary hyperparathyroidism (pHPT) that we followed up in order to share our clinical experience.
Material and Method: 171 patients, who were followed up between March 2008 and July 2010 in our Endocrinology and Metabolic Diseases Clinic with the diagnosis of PHPT, were included in the study. Serum total calcium (Ca+2), phosphorus (P), albumin, creatinine, parathormone (PTH), 25-hydroxyvitamine D3, results of ultrasonography (US), 24-hour Ca+2, P and creatinine measurements, 99mTc-sestamibi (MIBI), single photon emission tomography (SPECT), magnetic resonance imaging (MRI), bone mineral densitometer, urinary US, treatments that were administered as well as postoperative pathological results of the patients, were evaluated.
Results: Of the 171 patients, 137 were women (80,1%) and 34 were men (19,9%). The mean age of the patients was 55.3±11.6 years (25-80), and the mean serum total Ca+2 was 11.3±0.8 mg/dl, P was 2.6±0.5 mg/dl, PTH was 27.9±33.6 pmol/L, 25-hydroxyvitamine D3 was 13.5±12.3 ng/ml, 24 hour urine Ca+2 was 350.8±277.2 mg. 34 (19,9%) patients had nephrolithiasis while 96 (56,1%) had osteoporosis. In three patients, PHPT was the component of multiple endocrine neoplasia syndromes. Parathyroid pathology was detected in 84.2% of patients by US, in 61.0% by MIBI, in 66.4% by SPECT, and in 55.3% using MRI. While the most common location for parathyroid adenoma was the left lower lob of parathyroid (50.0%), ectopic (mediastinal) parathyroid adenoma was detected in 2.9% of patients. Pathological analysis revealed adenoma in 89.7%, hyperplasia in 4.4% and carcinoma in 1.5% of patients. In six patients (4,4%), no lesion was detected at surgery.
Discussion: As a result of the routine measurements of calcium levels in many centers, the incidence of asymptomatic PHPT seems to be increased. Surgery is the only definitive treatment for primary hyperparathyroidism. Widespread use of imaging techniques increases the success rate of surgery. Turk Jem 2012; 16: 64-8

ÖZET

Amaç: Klinik deneyimimizi paylaşmak için primer hiperparatiroidizm (PHPT) ile takip ettiğimiz hastaların demografik ve klinik özelliklerini bildirmeyi amaçladık.
Gereç ve Yöntem: Mart 2008-Temmuz 2010 tarihleri arasında Endokrinoloji ve Metabolizma Hastalıkları Kliniği’nde PHPT tanısı konan 171 hasta çalışmaya dahil edildi. Hastaların serum total kalsiyum (Ca+2), fosfor (P), albümin, kreatinin, parathormon (PTH), 25-hidroksivitamin D3 ve 24 saatlik idrar Ca+2, P ve kreatinin değerleri ile ultrasonografi (US), 99mTc-sestamibi (MIBI), single photon emission computed tomography (SPECT), manyetik rezonans (MR), kemik mineral dansitometri, üriner US, uygulanan tedaviler ve opere olan hastaların postoperatif patoloji sonuçları değerlendirildi.
Bulgular: 171 hastanın 137’si kadın (%80,1), 34’ü erkekti (%19,9). Hastaların yaş ortalaması 55,3±11,6 yıl (25-80), ortalama serum total Ca+2 11,3±0,8 mg/dl, P 2,6±0,5 mg/dl, PTH 27,9±33,6 pmol/L, 25-hidroksivitamin D3 13,5±12,3 ng/ml, 24 saatlik idrar Ca+2 350,8±277,2 mg/24 saat idi. Hastaların 34’ünde (%19,9) nefrolityazis, 96’sında (%56,1) osteoporoz mevcuttu. Üç hastada PHPT Multiple Endokrin Neoplazi Sendromu komponenti idi. Ultrasonografi ile %84,2 paratiroid patolojisi görüntülenebilirken, MIBI ile %61,0, SPECT ile %66,4 ve MR ile %55,3 görüntülenebildi. Paratiroid adenomlarının en sık yerleşim yeri sol alt paratiroid loju (%50,0) iken %2,9 ektopik (mediastinal) paratiroid adenomu saptandı. Patolojide %89,7 hastada adenom, %4,4 hastada hiperplazi ve %1,5 hastada karsinom saptandı. Altı hastada (%4,4) operasyonda lezyon bulunamadı.
Tartışma: Kalsiyum ölçümlerinin rutin olarak pekçok merkezde kullanılmasıyla asemptomatik PHPT sıklığı artmıştır. Primer hiperparatiroidinin kesin tedavisi cerrahidir. Görüntüleme yöntemlerinin yaygın kullanımı cerrahi başarısını arttırmaktadır. Türk Jem 2012; 16: 64-8