Recognition of primary hyperparathyroidism: Delayed time course from hypercalcemia to surgery
Recognition of primary hyperparathyroidism: Delayed time course from hypercalcemia to surgery
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DOI：
10.1016/j.surg.2019.07.031
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发表时间：
2020-02-01
期刊：
影响因子：
3.8
通讯作者：
Siperstein, Allan E.
中科院分区：
文献类型：
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作者：
Naples, Robert;Shin, Joyce J.;Siperstein, Allan E.
背景：对原发性甲状旁腺功能亢进的认识不足会导致诊断和手术治疗的延误。我们的目的是建立一个原发性甲状旁腺功能亢进症的时间过程，从最初的高钙血症手术，并评估的影响，这一时间course.Methods手术转诊指南：回顾性分析进行甲状旁腺切除术原发性甲状旁腺功能亢进症在2013年在克利夫兰诊所的所有患者。患者按照2008年手术指南的适应症、年龄、钙值、骨质疏松症、肾结石史、24小时尿钙值和估计肾小球滤过率进行分层。结果：219例散发性原发性甲状旁腺功能亢进患者接受了初次手术。排除了23例（10.5%）正常血钙患者。137例（70%）符合客观指南标准的患者从初始高钙血症到手术的时间为3.9年，59例（30%）不符合客观指南标准的患者为3.8年（P = 0.87）。按年龄11.5 mg/dL分层显示手术时间较早。然而，骨质疏松症，肾结石，24小时尿钙值，估计肾小球滤过率没有impacts.Conclusion：有一个延迟的时间过程中散发性原发性甲状旁腺功能亢进症患者从最初的高钙血症手术。尽管公布了客观标准，但接受手术的患者中有三分之一不符合标准，这表明临床医生和患者决策的重要性。此外，骨质疏松症和肾结石患者可以从手术治疗中显著获益，但对手术时间没有明显影响。总体而言，客观指南标准对转诊模式没有影响，建议进行修订。(C)2019爱思唯尔公司All rights reserved.
Background: Under recognition of primary hyperparathyroidism can lead to delays in diagnosis and surgical management. We aimed to establish a time course for primary hyperparathyroidism from initial hypercalcemia to surgery and evaluate the impact of guidelines for surgical referral on this time course.Methods: A retrospective review was conducted on all patients undergoing parathyroidectomy for primary hyperparathyroidism in 2013 at the Cleveland Clinic. Patients were stratified by adherence to 2008 indications for surgery guidelines, age, calcium values, osteoporosis, history of nephrolithiasis, 24-hour urinary calcium values, and estimated glomerular filtration rate.Results: 219 patients with sporadic primary hyperparathyroidism underwent initial surgery. Twenty-three (10.5%) normocalcemic patients were excluded. Time course from initial hypercalcemia to surgery was 3.9 years for 137 (70%) patients who met objective guideline criteria versus 3.8 years for 59 (30%) patients who did not meet objective guideline criteria (P = .87). Stratification by age 11.5 mg/dL revealed earlier times to surgery. However, osteoporosis, nephrolithiasis, 24-hour urinary calcium values, and estimated glomerular filtration rate had no impact.Conclusion: There is a delayed time course for patients with sporadic primary hyperparathyroidism from initial hypercalcemia to surgery. Despite published objective criteria, one third of the patients who underwent surgery did not meet criteria, signifying the importance of clinician and patient decision making. Furthermore, patients with osteoporosis and nephrolithiasis who can significantly benefit from surgical cure have no apparent impact on the time to surgery. Overall, the objective guideline criteria have no effect in referral patterns suggesting a call for revision. (C) 2019 Elsevier Inc. All rights reserved.