Опыт диагностики и хирургического лечения первичного гиперпаратиреоза

Abstract

Background . PHPT in developed countries is evaluated as the third endocrine epidemic following diabetes mellitus and thyroid gland diseases. Materials and methods. 36 patients ill with hyperparathyroidism had been operated. The number of women prevailed and was equal to 81% (29 women) (c2 = 26.89, p = 0.0000). The age of the patients ranged from 33 up to 82. 17 patients had a mixed form of PHPT, 10 patients had a kidney form and 9 patients had an osseous form of the disease. Results . Pre-operative ionized calcium median significance was 1.6 mmol/l. Mild degree of hypercalcemia was observed in 26 patients (72%), moderate degree was observed in 4 patients (11%) and 6 patients (17%) had a severe degree of hypercalcemia. Pre-operative PTH median was 169.95 pg/ml. The severity of the condition of the patients ill with PHPT was confirmed by the presence of hypercalcemia before the surgery which revealed in moderate statistically significant correlation of ionized calcium level with PTH level (r = 0,38, while p = 0,02) and adenoma size (r = 0.48, while p = 0.03). To provide adenoma topical diagnostics we used not less than 2 instramental investigation techniques. PTGs adenoma data were confirmed by ultrasonic examination and scintigraphy not more than in 79% and 72% of cases respectively, and MRI confirmed 88,2% of cases. One or two PTG adenomas were removed in all patients. Al together 65 PTG adenomas were removed. Associating thyroid gland pathology was marked in 88% of cases (28 patients). Ionized calcium median was decreasing statictically significantly up to 1.14 mmol/l (0.46 mmol/l decrease – 29% while p = 0.00001) the day following the surgery. PTH value decreased significantly up to 70.45 pg/ml after the surgery (99.5 pg/ml – 58% decrease while p = 0.00001). Conclusion . PHPT is more often met in women above 50 years old. Combined TG and PTG lesions were observed in 88% of cases and they demand simultaneous surgery and further investigation. More than one PTG adenoma was observed in 81% (29 patients) of cases and this is not considered to be typical for PHPT according to scientific data. More than one instrumental investigation methods are necessary for PTG adenomas topical diagnostics. We should be critical towards pre-operative data and keep in mind the possibility of multiple PTG lesion and apply the rule of symmetrical bilateral PTG location.