Screening for primary hyperparathyroidism in a tertiary stone clinic, a useful endeavor.
Screening for primary hyperparathyroidism in a tertiary stone clinic, a useful endeavor.
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在三级结石诊所筛查原发性甲状旁腺功能亢进症是一项有益的努力。
DOI：
10.1007/s11255-020-02476-0
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发表时间：
2020
影响因子：
2
通讯作者：
Assimos,DeanG
中科院分区：
文献类型：
--
作者：
Boyd,CarterJ;Wood,KyleD;Singh,Nikhi;Whitaker,Dustin;McGwin,Gerald;Chen,Herbert;Assimos,DeanG
原发性甲状旁腺功能亢进（1HPT）与肾结石的发生有关。我们的目的是确定在三级结石诊所评估SF之间的1HPT的患病率，并确定它是否是具有成本效益的屏幕为这种condition.MethodsWe回顾性审查了742成人SF看到的一个单一的泌尿外科医生从2012年至2017年所有的人进行了筛选1HPT与一个完整的血清甲状旁腺激素（iPTH）和钙。1HPT的诊断基于高钙血症伴iPTH不适当升高或正常血清钙高和iPTH不适当升高。经颈部手术探查证实。结果：53例（7.1%）被诊断为1HPT。15例（28%）有高钙血症和iPTH不适当升高，38例（72%）有正常血清钙水平高和iPTH不适当升高。基于对既往实验室结果的审查，9例（17.0%）患者的初级保健医生忽略/漏诊了潜在诊断。在筛选后的5年、10年、15年和20年间隔进行成本建模。根据我们的患病率数据，复发的历史风险和公布的成本数据结石治疗，成本节约筛选实现在10 years.ConclusionThese结果支持筛查原发性甲状旁腺功能亢进症的患者在三级转诊设置评估。
Introduction and objectivesPrimary hyperparathyroidism (1HPT) is associated with the risk of developing kidney stones. Our objective was to determine the prevalence of 1HPT amongst SF evaluated at a tertiary stone clinic and determine if it is cost-effective to screen for this condition.MethodsWe retrospectively reviewed 742 adult SF seen by a single urologic surgeon from 2012 to 2017 all of who were screened for 1HPT with an intact serum PTH (iPTH) and calcium. The diagnosis of 1HPT was based on the presence of hypercalcemia with an inappropriately elevated iPTH or a high normal serum calcium and an inappropriately elevated iPTH. The diagnosis was confirmed by surgical neck exploration. Published cost data and stone recurrence rates were utilized to create a cost-effectiveness decision tree.Results obtainedFifty-three (7.1%) were diagnosed with 1HPT. 15 (28%) had hypercalcemia and inappropriately elevated iPTH, 38 (72%) had high normal serum calcium levels and inappropriately elevated iPTH. The potential diagnosis was ignored/missed by primary care physicians in 9 (17.0%) based on a review of prior lab results. Cost modeling was undertaken for 5, 10, 15, and 20-year intervals after screening. Based on our prevalence data, historical risks for recurrence and published cost data for stone treatments, cost savings in screening are realized at 10 years.ConclusionThese results support screening for primary hyperparathyroidism in patients evaluated in a tertiary referral setting.