Analysis of diagnosis and treatment of 89 patients with primary hyperparathyroidism

Abstract

Objective To summarize the clinical manifestations, diagnosis and treatment of the primary hyperparathyroidism(PHPT). Methods The clinical data of 89 patients with PHPT admitted during 1991 to 2013 were retrospectively analyzed. Results The mean age of the 89 patients was(44.7±15.8)years(13-86 years), male to female ratio was 1∶2.1. 79% of the 89 patients were symptomatic. 62% of the 89 patients had been misdiagnosed. 52% had been misdiagnosed as kidney stones or bone diseases(fracture, tumor, and metabolic bone disease). The remaining subjects had been misdiagnosed as peptic ulcer, rheumatoid arthritis or pancreatitis. The median serum parathyroid hormone(PTH)level in 88 patients was 697.3 pg/ml(26.4-5 000.0 pg/ml, n=88), the mean serum calcium level was(3.03±0.56)mmol/L(n=88). The 24 h urine calcium was(10.02±4.73)mmol/24 h(n=36). The sensitivity of localization of the parathyroid lesions with technetium-99mmethoxy-isobutyl-isonitrile(99mTc-MIBI)was 96%, being higher than ultrasound(71%), CT(71%), and MRI(72%)(P<0.05, respectively). 79 cases had been treated surgically. The median serum PTH level was 748.2 pg/ml(46.1-5 000.0 pg/ml)before surgery, 79.9 pg/ml(11.35-838.0 pg/ml)15 minutes after surgical removal of the lesions(P<0.05 vs preoperative)and 22.9 pg/ml(2.3-1 203.0 pg/ml)on the first postoperative day(P<0.05 vs preoperative). Serum calcium was(3.03±0.56)mmol/L before surgery, (2.25±0.37)mmol/L on the first postoperative day(P<0.05 vs preoperative)and(2.08±0.36)mmol/L on the second postoperative day(P<0.05 vs preoperative). After the operation, 42 cases(53%)had perioral and limb numbness, 2 cases(3%)had hoarseness of voice and bucking while drinking, 1 case(1%) had tetany. All these symptoms were improved after calcium supplementation. 67 patients(85%)had been diagnosed as parathyroid adenoma pathologically, 7 patients(9%)as hyperplasia, 3 patients(4%)as cysts, and 2 patients(3%)as carcinoma. Among 67 cases of adenomas, 62 cases had a single parathyroid adenoma, 1 case with multiple parathyroid adenomas, and 4 cases with ectopic parathyroid adenomas. The ectopic lesions were located below the thyroid, in the rib cage, left mediastinum, and above the sternum. Conclusions The majority of domestic PHPT was symptomatic. Delayed diagnosis of PHPT is still very frequent. The clinical presentations of PHPT are variable, determination of serum calcium and PTH level simultaneously is the keypoint for early identification and diagnosis of PHPT. The clinician should be familiar with the various clinical manifestations of PHPT and thus enhance understanding of pathogenesis of the disease. 99mTc-MIBI scintigraphy remained the first choice of preoperative imaging localization of the parathyroid lesions, followed by ultrasound, CT, and MRI. Surgical removal of the lesions is effective and safe. (Chin J Endocrinol Metab, 2015, 31: 300-305) Key words: Primary hyperparathyroidism; Diagnosis; Treatment