Diagnostic and curative aspects in the management of primary hyperparathyroidism. Clinic experience

Abstract

Background. Primary hyperparathyroidism actualy represents a subject discussed in literature, which is characterized by hypersecretion of PTH and disappearance of feedback between the production of PTH and serum calcium level, which is related to adenoma in 95% of cases Objective of the study. Assessment of indications for surgical treatment and its efficacy in HPP. Material and Methods. This retrospective study was performed on 74 patients, hospitalized in VAE Surgery department, SCR during 2015-2020 years, diagnosed with primary HPP. Patients were evaluated clinically, paraclinically by using medical histories sheet and surgical protocols. Results. 74 cases with primary HPP were evaluated, 11 men (14,47%) and 65 women (85,5%), with mean age (50-70). Clinical manifestations: osteoarticular – 57,9%, n=44), renal – (25%, n=19), neuropsychological – (17,1%, n=13), digestive – (18.4%, n=14). Positive diagnosis: calcium level, mean calcium level was 12.1±0.47 mg/dL, phosphorus 500±75.05 md/dL, while PTH mean was ±1033 pg/ml. On echographic, mean size of pathological parathyroids was 1.0-3.0 cm. The surgical approach was performed in 100% cases. Conclusion. A positive diagnosis of HPP involves the determination of serum calcium, PTH. Localization of adenoma was performed via USG, choise of treatment – surgical. The post-operative mortality rate was null. Introducere. Hiperparatiroidismul primar se caracterizează prin secreţia exagerată de PTH şi dispariţia fenomenului de feedback dintre producţia PTH şi nivelul seric al calciului, acestea se datorează adenoamelor în 95% cazuri, în 5%-hiperplaziei paratiroidiene. Scopul lucrării. Aprecierea indicaţiilor pentru tratamentul chirugical şi eficacităţii acestuia în HPP. Material și Metode. În Clinica 2 Chirurgie, pe parcursul anilor 2015-2020, au fost operaţi 76 pacienţi cu hiperparatiroidism primar. A fost efectuat un studiu retrospectiv asupra bolnavilor internaţi în secţia chirugie VAE, SCR în perioda 2015-2020, diagnosticaţi cu HPP primar. Pacienţii au fost evaluaţi clinic, paraclinic, imagistic şi tactica tratamentului. Rezultate. 76 de cazuri au fost cu HPP primar, 11 bărbaţi (14,47%) şi 65 femei (85,5%), cu o vârstă medie 50-70 ani. Manifestările clinice: osteo-articulare (57,9%, n=44), renale (25%, n=19), neuro-psihice (17,1%, n=13), digestive (18.4%, n=14). Diagnostic pozitiv: dozarea calcemiei de 12.1±0.47 mg//dL, a fosfatemiei de 500±75.05 mg/dL, iar PTH a avut valoarea medie ±1033 pg/ml. Ecografic, dimensiunea medie a paratiroidelor a fost de 1.0-3.0 cm. Toţi pacienţii au fost operaţi, înlăturându-se adenomul. Postoperator, s-a confirmat scăderea PTH şi normalizarea calciului seric. Concluzii. Diagnosticul pozitiv al HPP implică dozarea calciului seric şi a PTH. Adenomul este localizat prin USG, tratamentul chirurgical este singurul tratament curativ al HPP, mortalitatea postoperatorie a fost nulă.