CLINICAL MANIFESTATIONS OF PRIMARY HYPERPARATHYROIDISM BEFORE AND AFTER PARATHYROIDECTOMY - A CASE-CONTROL STUDY
CLINICAL MANIFESTATIONS OF PRIMARY HYPERPARATHYROIDISM BEFORE AND AFTER PARATHYROIDECTOMY - A CASE-CONTROL STUDY
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DOI：
10.1097/00000658-199509000-00017
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发表时间：
1995-09-01
影响因子：
9
通讯作者：
CLARK, OH
中科院分区：
文献类型：
--
作者：
CHAN, AK;DUH, QY;CLARK, OH
背景：美国国立卫生研究院召开了一次关于“无症状”原发性甲状旁腺功能亢进患者管理的共识会议，但对这种情况没有明确的定义。因此，作者记录了未选择的原发性甲状旁腺功能亢进患者的临床表现和这些表现的频率，并确定这些临床表现在甲状旁腺切除术后是否消失。方法对1986年1月至1991年6月间分别行甲状旁腺切除术或甲状腺切除术的152例原发性甲状旁腺功能亢进患者和132例非毒性甲状腺疾病的对照患者进行研究。所有患者在首次就诊时都收到一份调查问卷，手术后再次收到同样的调查问卷。患者还被问及他们对手术成功的看法。80%甲状旁腺患者和70.5%甲状腺患者完成了问卷调查，平均随访时间为20个月。结果7例（4.6%）原发性甲状旁腺功能亢进患者无症状，26例（17.1%）患者无相关症状，其中74.3%患者血钙水平低于12 mg/dL。原发性甲状旁腺功能亢进症患者的症状包括疲劳、乏力、虚弱、多饮、多尿、夜尿、关节痛、骨痛、便秘、抑郁、厌食、恶心、胃灼热以及肾结石和血尿等相关情况，在原发性甲状旁腺功能亢进患者中比在甲状腺控制患者中更常见（p < 0.05）。甲状旁腺切除术后，只有8例（5.3%）患者的症状或相关情况没有任何改善。57%的甲状旁腺患者和30%的甲状腺患者在手术后感觉整体好转；29%甲状旁腺患者主观力量增强，而甲状腺患者主观力量增强的比例为13%；37%的甲状旁腺患者和13%的甲状腺患者声称他们没有那么抑郁。结论经彻底检查，原发性甲状旁腺功能亢进患者很少无症状或无相关疾病，大多数患者在甲状旁腺切除术成功后主观改善。
Background There has been an National Institutes of Health consensus meeting concerning the management of patients with ''asymptomatic'' primary hyperparathyroidism, yet there is no clear definition of this condition. The authors, therefore, documented the clinical manifestations and frequencies of these manifestations in unselected patients with primary hyperparathyroidism and determined whether these clinical manifestations resolved after parathyroidectomy.Method The authors studied 152 unselected consecutive patients with primary hyperparathyroidism and 132 control patients with nontoxic thyroid disorders who were treated by parathyroidectomy or thyroidectomy, respectively, between January 1986 and June 1991. Ail patients received a questionnaire during their initial office visits and the same questionnaire again after their operations. Patients were also questioned about their perception of the success of the operation. Eighty percent of the parathyroid patients and 70.5% of the thyroid patients completed the questionnaires, and the mean follow-up time was 20 months.Results Only 7 (4.6%) patients with primary hyperparathyroidism had no symptoms, and 26 (17.1%) had no associated conditions despite 74.3% of these patients having serum calcium levels less than 12 mg/dL. Symptoms including fatigue, exhaustion, weakness, polydipsia, polyuria, nocturia, joint pain, bone pain, constipation, depression, anorexia, nausea, heartburn, and associated conditions, including nephrolithiasis, and hematuria occurred more often in patients with primary hyperparathyroidism than in the thyroid control patients (p < 0.05). After parathyroidectomy, only eight (5.3%) patients failed to have any improvement in symptoms or associated conditions. Fifty-seven percent of the parathyroid patients verses 30% of the thyroid patients felt better overall after the operation; strength subjectively improved in 29% of parathyroid patients Versus 13% in thyroid patients; thirty-seven percent of the parathyroid patients versus 13% of the thyroid patients claimed they were less depressed.Conclusion When examined thoroughly, few patients with primary hyperparathyroidism were asymptomatic or without associated conditions, and most patients experienced subjective improvement after successful parathyroidectomy.