Normocalcaemic primary hyperparathyroidism: what is the role of parathyroid surgery?

摘要: Primary hyperparathyroidism (PHPT) is classically associated with both an elevated or 'inappropriately normal' parathyroid hormone (PTH) level and raised serum calcium. However, in clinical practice, increasing numbers of patients present PTH but normal calcium, renal function vitamin D; this known as normocalcaemic PHPT (nPHPT). Studies investigating the presentation condition have shown that may hypertension, nephrolithiasis, impaired glucose tolerance, osteoporosis fragility fractures. The prevalence such complications nPHPT similar to classical hypercalcaemic (hPHPT). Although National Institute for Health Care Excellence (NICE) developed guidelines management generally, a consensus yet be reached on optimal specifically. A review literature parathyroidectomy treatment revealed were more likely multi-glandular disease significantly less had intra-operative fall >50% compared those hPHPT. These findings demonstrate are receive bilateral neck explorations require remedial surgery hPHPT patients. Following surgery, improvements bone mineral density (BMD) stones generally observed nPHPT. Where not possible, medical alendronate has been effective Given higher incidence multi-gland greater possibility nPHPT, careful consideration risks benefits should made individualised basis performed by surgeons experienced four gland exploration.