Clinical analysis of 30 cases of asymptomatic primary hyperparathyroidism / 中华内分泌外科杂志

Objective:To analyze the clinical and pathological features of asymptomatic primary hyperparathyroidism (PHPT) .Methods:A retrospective analysis was carried out in terms of the clinical characteristics and pathological data in 30 patients with asymptomatic PHPT and 86 patients with typical PHPT hospitalized in the Department of Endocrinology and General Surgery of Beijing Jishuitan Hospital from Jan. 2013 to Dec. 2018. There were 7 males (23.3%) and 23 females (76.7%) , with a male to female ratio of 1:3.3. The average age was 56.9±13.3 years. In typical PHPT group, there were 32 males (37.2%) and 54 females (62.8%) , with the average age of 46.4±17.0 years. Bone metabolism indicators included bone density and bone biochemical markers (parathyroid hormone, 25-hydroxyvitamin D and alkaline phosphatase) . The t test was used to compare normally distributed variables, the Mann-Whitney rank sum test was used to compare skewed distributed variables, and the χ 2 test was used to compare enumeration data. Results:The median serum parathyroid hormone and alkaline phosphatase were 144.2 (108.1, 207.0) pg/ml and 80.0 (53.7, 105.5) IU/L respectively, the average serum concentration of calcium was 2.80±0.20 mmol/L, which were significantly lower than those of the classic group ( P<0.05) . The median serum 25-hydroxyvitamin D was 12.14 (7.87, 14.38) ng/ml, which was higher than that of the classic group ( P<0.001) . Ten patients (33.3%) developed osteoporosis, and the incidence was lower than that of the classic group ( P< 0.001) . The median tumor weight was 0.80 (0.25, 1.98) g, significantly smaller than that in the classical group ( P=0.003) . There were 26 cases (86.7%, including 2 atypical parathyroid adenomas) of parathyroid adenomas and 4 cases (13.3%) of hyperplasia. Conclusions:The asymptomatic PHPT has the same sex ratio as the classic type, mainly female, but the average age is significantly higher than that in the classic type. Although asymptomatic PHPT in this study are all benign lesions, abnormal bone biochemical indicators, especially vitamin D deficiency, are common, which also lead to osteoporosis.

Clinical characteristics of the patients with asymptomatic primary hyperparathyroidism / 中南大学学报(医学版)

OBJECTIVES@#The prevalence of asymptomatic primary hyperparathyroidism (PHPT) in China is lower than that in European and American countries and the study about the characteristics of asymptomatic PHPT was rare in China. This study aims to explore the characteristics of asymptomatic PHPT.@*METHODS@#Clinical data of 150 patients with PHPT confirmed by operation and pathological examination were retrospectively analyzed. The patients were assigned into a symptomatic PHPT group (@*RESULTS@#The proportion of adenomas was higher than that of adenocarcinoma in the asymptomatic PHPT group. The proportion of the first diagnosis due to hypercalcemia found via biochemical examination in the asymptomatic PHPT group was higher than that in the symptomatic PHPT group (76.92% vs 25.81%, @*CONCLUSIONS@#Only a minority of PHPT patients are asymptomatic. Compared with the symptomatic PHPT patients, the primary cause of diagnosis is hypercalcemia, the duration of diagnosis and the diameter of parathyroid gland are shorter, the levels of serum calcium, and PTH are lower, the proportion of adenomas, vitamin D, and the BMD of L

Hiperparatiroidismo primario asintomático en mujeres / Asymptomatic primary hyperparathyroidism in women

El hiperparatiroidismo primario puede tener diferentes características. Una de ellas es la forma asintomática. Esta es una variante leve del hiperparatiroidismo primario hipercalcémico, que se caracteriza por una calcemia no mayor a 1 mg/dl sobre el límite superior del método, hormona paratiroidea intacta (PTHi) elevada, ausencia de litiasis renal, deterioro de la función renal y de osteoporosis, edad menor de 50 años, y calciuria menor a 400 mg/día. No es una entidad quirúrgica, pero en su evolución puede llegar a serlo. Se estudiaron 24 mujeres postmenopáusicas, todas mayores de 50 años, con diagnóstico de hiperparatiroidismo asintomático, se describieron las manifestaciones clínicas, los cambios densitométricos, los parámetros bioquímicos y del remodelado óseo y se compararon los resultados con las variantes clásica y normocalcémica de la enfermedad. Se establecieron los criterios diagnósticos y se observó que solo 2 (8.3%) de las pacientes, durante un seguimiento de 44 ± 12 meses tuvo necesidad de paratiroidectomía. En definitiva, el hiperparatiroidismo primario asintomático es una alteración benigna, de seguimiento clínico periódico que, en pocas ocasiones, durante el seguimiento puede requerir cirugía.

Primary hyperparathyroidism may have different characteristics. One is the asymptomatic form. This is a mild variant of hypercalcemic hyperparathyroidism, characterized by a calcemia not greater than 1 mg/dl above the upper limit of the method, a high intact parathyroid hormone (iPTH), absence of renal stones, renal function impairement, and osteoporosis, less than 50 years of age, and less than 400 mg/day calciuria. It is not a surgical entity, but its evolution may require it. Twenty-four postmenopausal women, all older than 50 years, with a diagnosis of asymptomatic hyperparathyroidism, were studied. Clinical manifestations, densitometric changes, biochemical parameters and bone remodeling were analyzed and the results were compared with the classic and normocalcemic variants of the disease. Diagnostic criteria were established and observed that only 2 (8.3%) of patients, during a follow up of 44 ± 12 months, had need for a parathyroidectomy. In conclusion, the asymptomatic primary hyperparathyroidism is a benign disorder, of periodic clinical follow-up, which rarely may require surgery.