Experience of diagnostics and surgical treatment primary hyperparathyroidism

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...

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Main Authors: Igor V. Makarov, Rudolf A. Galkin, Natasha A. Prokophyeva, Viktoria A. Boltovskaja, Roman M. Romanov, Daria O. Hohlova
Format: Article
Language:Russian
Published: Endocrinology Research Centre 2017-09-01
Series:Эндокринная хирургия
Subjects:
Online Access:https://surg-endojournals.ru/serg/article/viewFile/8763/6914
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author Igor V. Makarov
Rudolf A. Galkin
Natasha A. Prokophyeva
Viktoria A. Boltovskaja
Roman M. Romanov
Daria O. Hohlova
author_facet Igor V. Makarov
Rudolf A. Galkin
Natasha A. Prokophyeva
Viktoria A. Boltovskaja
Roman M. Romanov
Daria O. Hohlova
author_sort Igor V. Makarov
collection DOAJ
description 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.
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spelling doaj.art-d1516d25294544ec969c1570dec44d482022-12-21T22:55:02ZrusEndocrinology Research CentreЭндокринная хирургия2306-35132310-39652017-09-01112818910.14341/serg2017281-898316Experience of diagnostics and surgical treatment primary hyperparathyroidismIgor V. Makarov0Rudolf A. Galkin1Natasha A. Prokophyeva2Viktoria A. Boltovskaja3Roman M. Romanov4Daria O. Hohlova5Samara State Medical UniversitySamara State Medical UniversitySamara State Medical UniversitySamara railway clinical hospitalSamara State Medical UniversitySamara State Medical UniversityBackground. 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.https://surg-endojournals.ru/serg/article/viewFile/8763/6914primary hyperparathyroidismsurgical treatment
spellingShingle Igor V. Makarov
Rudolf A. Galkin
Natasha A. Prokophyeva
Viktoria A. Boltovskaja
Roman M. Romanov
Daria O. Hohlova
Experience of diagnostics and surgical treatment primary hyperparathyroidism
Эндокринная хирургия
primary hyperparathyroidism
surgical treatment
title Experience of diagnostics and surgical treatment primary hyperparathyroidism
title_full Experience of diagnostics and surgical treatment primary hyperparathyroidism
title_fullStr Experience of diagnostics and surgical treatment primary hyperparathyroidism
title_full_unstemmed Experience of diagnostics and surgical treatment primary hyperparathyroidism
title_short Experience of diagnostics and surgical treatment primary hyperparathyroidism
title_sort experience of diagnostics and surgical treatment primary hyperparathyroidism
topic primary hyperparathyroidism
surgical treatment
url https://surg-endojournals.ru/serg/article/viewFile/8763/6914
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AT rudolfagalkin experienceofdiagnosticsandsurgicaltreatmentprimaryhyperparathyroidism
AT natashaaprokophyeva experienceofdiagnosticsandsurgicaltreatmentprimaryhyperparathyroidism
AT viktoriaaboltovskaja experienceofdiagnosticsandsurgicaltreatmentprimaryhyperparathyroidism
AT romanmromanov experienceofdiagnosticsandsurgicaltreatmentprimaryhyperparathyroidism
AT dariaohohlova experienceofdiagnosticsandsurgicaltreatmentprimaryhyperparathyroidism