Diagnosis and Treatment of Asymptomatic Primary Hyperparathyroidism Duo to Parathyroid Adenoma（A Retrospective Analysis of 24 Cases）_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

张平 , 张大林 , 贺亮 , 董文武 , 王志宏 , 贾爱庆 ,  张浩

Corresponding author：

张浩, Email: haozhang@mail.cmu.edu.cn

Keywords：

原发性甲状旁腺功能亢进; 无症状型; 治疗

Video：

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目的　探讨甲状旁腺腺瘤所致无症状原发性甲状旁腺功能亢进症（PHPT）的诊断和治疗。
方法　回顾性分析中国医科大学附属第一医院1990年1月至2013年4月期间收治的24例甲状旁腺腺瘤所致无症状PHPT患者的临床资料。
结果　24例甲状旁腺腺瘤所致无症状PHPT患者中男9例，女15例；年龄（47.92±12.96）岁。均无骨关节疼痛、病理性骨折、泌尿系结石或胃肠道症状等典型PHPT的临床表现，均为体检和并存或误诊为甲状腺疾病时发现。24例患者术前血钙升高18例，正常6例；血磷降低7例，正常17例；16例术前行血甲状旁腺激素检测患者中11例升高，正常5例；22例患者术前测定血碱性磷酸酶升高9例，正常13例。血钙与甲状旁腺激素均正常者4例，其中1例为体检时超声发现甲状旁腺病变，3例为手术治疗甲状腺疾病术中探查发现。24例患者术前均行超声检查，15例行甲状旁腺ECT检查，14例行甲状旁腺增强CT检查，阳性率分别为66.67% （16/24）、93.33% （14/15）及78.57% （11/14）。15例术前定性定位检查获得明确诊断，5例定性或定位检查高度怀疑甲状旁腺病变，4例术前误诊为甲状腺病变。均行甲状旁腺腺瘤切除，其中甲状旁腺腺瘤位于左侧上位2例、左侧下位9例、右侧上位2例、右侧下位11例。肿瘤最大径为（2.22±0.88） cm。24例患者中13例合并甲状腺病变。本组患者术后有8例出现手足、口周麻木，给予静脉或口服补钙后缓解，其余患者均无自觉症状。术后血钙及甲状旁腺激素均有不同程度下降，术后2周均降至正常范围。
结论　甲状旁腺腺瘤所致无症状PHPT临床症状不典型，血清钙和甲状旁腺激素同步升高即可诊断，具有手术指征的患者应积极手术治疗。

Citation： 张平,张大林,贺亮,董文武,王志宏,贾爱庆,张浩. Diagnosis and Treatment of Asymptomatic Primary Hyperparathyroidism Duo to Parathyroid Adenoma（A Retrospective Analysis of 24 Cases）. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2013, 20(11): 1298-1300. doi: Copy

1.	Melton LJ 3rd. The epidemiology of primary hyperparathyroidism in North America[J]. J Bone Miner Res， 2002， 17 Suppl 2：N12-N17.
2.	Mariani G， Gulec SA， Rubello D， et al. Preoperative localization and radioguided parathyroid surgery[J]. J Nucl Med， 2003， 44(9)：1443-1458.
3.	Bilezikian JP， Rubin M， Silverberg SJ. Asymptomatic primary hyperparathyroidism[J]. Arq Bras Endocrinol Metabol， 2006， 50(4)：647-656.
4.	Bilezikian JP， Potts JT Jr. Asymptomatic primary hyperparathyroidism：new issues and new questions-bridging the past with the future[J]. J Bone Miner Res， 2002， 17 Suppl 2：N57-N67.
5.	Starker LF， Mahajan A， Björklund P， et al. 4D parathyroid CT as the initial localization study for patients with de novo primary hyperparathyroidism[J]. Ann Surg Oncol， 2011， 18(6)：1723-1728. doi：10. 1245/s10434-010-1507-0.
6.	Arora S， Balash PR， Yoo J， et al. Benefits of surgeon-performed ultrasound for primary hyperparathyroidism[J]. Langenbecks Arch Surg， 2009， 394(5)：861-867.
7.	朱建东，陈余钿，卓文方，等. 甲状旁腺腺瘤26例临床诊治分析[J]. 肿瘤学杂志， 2010， 16(6)：501-502.
8.	Rubello D， Massaro A， Cittadin S， et al. Role of 99mTc-sestamibi SPECT in accurate selection of primary hyperparathyroid patients for minimally invasive radio-guided surgery[J]. Eur J Nucl Med Mol Imaging， 2006， 33(9)：1091-1094.
9.	Pata G， Casella C， Magri GC， et al. Financial and clinical implications of low-energy CT combined with 99mTechnetium-sestamibi SPECT for primary hyperparathyroidism[J]. Ann Surg Oncol， 2011， 18(9)：2555-2563.
10.	Harari A， Mitmaker E， Grogan RH， et al. Primary hyperparathyroidism patients with positive preoperative sestamibi scan and negative ultrasound are more likely to have posteriorly located upper gland adenomas (PLUGs)[J]. Ann Surg Oncol， 2011， 18(6)：1717-1722.
11.	王鸥，刑小平，孟迅吾，等. 无症状型原发性甲状旁腺功能亢进症临床特点分析[J]. 中国骨质疏松和骨矿盐疾病杂志， 2010， 3(1)：18-22.
12.	Bilezikian JP， Silverberg SJ. Clinical practice. Asymptomatic primary hyperparathyroidism[J]. N Engl J Med， 2004， 350(17)：1746-1751.
13.	Morris LG， Myssiorek D. When is surgery indicated for asymptomatic primary hyperparathyroidism[J]. Laryngscope， 2009， 119(12)：2291-2292.
14.	Bilezikian JP， Khan AA， Potts JT Jr. Guidelines for the management of asymptomatic primary hyperparathyroidism：summary statement from the third international workshop[J]. J Clin Endocrinol Metab， 2009， 94(2)：335-339.
15.	Silverberg SJ， Lewiecki EM， Mosekilde L， et al. Presentation of asymptomatic primary hyperparathyroidism：proceedings of the third international workshop[J]. J Clin Endocrinol Metab， 2009， 94(2)：351-365. doi：10. 1210/jc. 2008-1760.

1. Melton LJ 3rd. The epidemiology of primary hyperparathyroidism in North America[J]. J Bone Miner Res， 2002， 17 Suppl 2：N12-N17.
2. Mariani G， Gulec SA， Rubello D， et al. Preoperative localization and radioguided parathyroid surgery[J]. J Nucl Med， 2003， 44(9)：1443-1458.
3. Bilezikian JP， Rubin M， Silverberg SJ. Asymptomatic primary hyperparathyroidism[J]. Arq Bras Endocrinol Metabol， 2006， 50(4)：647-656.
4. Bilezikian JP， Potts JT Jr. Asymptomatic primary hyperparathyroidism：new issues and new questions-bridging the past with the future[J]. J Bone Miner Res， 2002， 17 Suppl 2：N57-N67.
5. Starker LF， Mahajan A， Björklund P， et al. 4D parathyroid CT as the initial localization study for patients with de novo primary hyperparathyroidism[J]. Ann Surg Oncol， 2011， 18(6)：1723-1728. doi：10. 1245/s10434-010-1507-0.
6. Arora S， Balash PR， Yoo J， et al. Benefits of surgeon-performed ultrasound for primary hyperparathyroidism[J]. Langenbecks Arch Surg， 2009， 394(5)：861-867.
7. 朱建东，陈余钿，卓文方，等. 甲状旁腺腺瘤26例临床诊治分析[J]. 肿瘤学杂志， 2010， 16(6)：501-502.
8. Rubello D， Massaro A， Cittadin S， et al. Role of 99mTc-sestamibi SPECT in accurate selection of primary hyperparathyroid patients for minimally invasive radio-guided surgery[J]. Eur J Nucl Med Mol Imaging， 2006， 33(9)：1091-1094.
9. Pata G， Casella C， Magri GC， et al. Financial and clinical implications of low-energy CT combined with 99mTechnetium-sestamibi SPECT for primary hyperparathyroidism[J]. Ann Surg Oncol， 2011， 18(9)：2555-2563.
10. Harari A， Mitmaker E， Grogan RH， et al. Primary hyperparathyroidism patients with positive preoperative sestamibi scan and negative ultrasound are more likely to have posteriorly located upper gland adenomas (PLUGs)[J]. Ann Surg Oncol， 2011， 18(6)：1717-1722.
11. 王鸥，刑小平，孟迅吾，等. 无症状型原发性甲状旁腺功能亢进症临床特点分析[J]. 中国骨质疏松和骨矿盐疾病杂志， 2010， 3(1)：18-22.
12. Bilezikian JP， Silverberg SJ. Clinical practice. Asymptomatic primary hyperparathyroidism[J]. N Engl J Med， 2004， 350(17)：1746-1751.
13. Morris LG， Myssiorek D. When is surgery indicated for asymptomatic primary hyperparathyroidism[J]. Laryngscope， 2009， 119(12)：2291-2292.
14. Bilezikian JP， Khan AA， Potts JT Jr. Guidelines for the management of asymptomatic primary hyperparathyroidism：summary statement from the third international workshop[J]. J Clin Endocrinol Metab， 2009， 94(2)：335-339.
15. Silverberg SJ， Lewiecki EM， Mosekilde L， et al. Presentation of asymptomatic primary hyperparathyroidism：proceedings of the third international workshop[J]. J Clin Endocrinol Metab， 2009， 94(2)：351-365. doi：10. 1210/jc. 2008-1760.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Diagnosis and Treatment of Asymptomatic Primary Hyperparathyroidism Duo to Parathyroid Adenoma（A Retrospective Analysis of 24 Cases）

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