Diagnosis and treatment of primary hyperparathyroidism (20 years of own experience and literature review)

Abstract

Background. Currently, primary hyperparathyroidism (pHPT) is the third most common endocrine disease after thyroid gland pathology and diabetes mellitus. Untimely diagnosis leads to a severe course of the disease with the development of disabling deformations — osteoporotic fractures, recurrent stone formation in the urinary tract, gastrointestinal bleeding, etc., as well as to an increased risk of premature death. The purpose of the study is to assess the dynamics of detection of thyroid disease (thyroid) for the period 2000–2019. Materials and methods. Since 2000, based on the surgical department of the clinic of the State Institution “V. Danilevsky Institute for Endocrine Pathology Problems of the National Academy of Medical Sciences of Ukraine”, 205 surgeries have been carried out for pHPT (in 188 women and 17 men: 91.7 and 8.3 %). Results. Since 2008, there has been a steady increase in the number of cases. The incidence of pHPT in women increases with age and becomes significantly higher at the age of 50–69 years. At the same time, the gap between women and men is widening, the reason for which needs to be studied. The proportional ratio of the number of patients with asymptomatic and clinically pronounced course persists for 20 years and is approximately 2 : 1. In countries where blood calcium screening has been introduced, the proportion of asymptomatic forms reaches 80 %. The obtained data confirm the fact of untimely diagnosis of pHPT in Ukraine, which requires the introduction of large-scale population screening in the form of a questionnaire survey and study of serum calcium. Conclusions. A positive contribution to the timely detection of pHPT can be made by activating the work of postgraduate (continuous) education institutions in this direction, primarily the departments of endocrinology based on endocrinological clinics with surgical departments.