Asemptomatik Primer Hiperparatiroidili Hastaların Cerrahi Endikasyonlarının Retrospektif Olarak Değerlendirilmesi: Tek-Merkez Deneyimi

Year 2024, Volume: 4 Issue: 2, 9 - 16, 31.08.2024

Derya Sema Yaman Kalender , Mehmet Sercan Erturk

Abstract

Amaç: Primer hiperparatiroidizm (PHPT), biyokimyasal taramalardaki ilerlemeler sayesinde tarihsel olarak
semptomatik bir hastalıktan ağırlıklı olarak asemptomatik bir duruma dönüşmüştür. Bu çalışma, asemptomatik PHPT hastalarında cerrahi endikasyonların ve sonuçların retrospektif değerlendirilmesini, hastalık prezantasyonundaki değişimi ve çeşitli faktörlere dayandırılan artan insidansı araştırmaktadır.
Gereç ve Yöntemler: Ocak 2017 ile Ocak 2022 arasında tanısı konulan asemptomatik PHPT olguları İzmir Katip Çelebi Üniversitesi, Atatürk Eğitim ve Araştırma Hastanesi Endokrinoloji ve Metabolizma Anabilim Dalı'nda detaylı olarak incelendi; olguların cerrahi endikasyonları 4. Uluslararası çalıştay asemptomatik primer hiperparatiroidizm kılavuzlarında belirtilen kriterlere göre değerlendirildi.
Bulgular: 48 hastanın (%98'i kadın, ortalama yaş 54,9 ± 5,9) %56,2'sinde en az bir cerrahi endikasyon mevcuttu; en yaygın olanları ise osteoporoz ve böbrek komplikasyonlarıydı.
Sonuç: Çalışma, 4. Uluslararası çalıştay tarafından belirlenen kriterleri vurgulayarak, hafif PHPT vakalarında paratiroidektomiyi önerme konusundaki ihtiyatlı yaklaşımı ele almaktadır. Uzun dönemli randomize araştırmaların bulunmamasına karşın, yeni meta-analizler ve gözlemsel çalışmalar fraktür oranlarında, kemik mineral yoğunluğunda, nefrolitiaziste, kardiyovasküler olaylarda ve yaşam kalitesinde sınırlı değişiklikler olduğunu ortaya koymaktadır. Cerrahi olmayan hastalarda uzun vadeli takipte cerrahinin faydaları konusundaki tartışma henüz kesinlik kazanmamıştır. Çalışmamız, cerrahi operasyona karar verme aşaması için değerli bilgiler katıyor ve bu hasta popülasyonunda cerrahinin uzun vadeli yararları ve riskleri hakkında daha fazla araştırma yapılması ihtiyacını vurguluyor. Bu retrospektif analiz, asemptomatik PHPT'ye yönelik cerrahi müdahalelere ilişkin anlayışımızı geliştirmeyi ve gelecekteki klinik
uygulamalara rehberlik etmeyi amaçlamaktadır.

Keywords

Primer hiperparatiroidi, hiperkalsemi, paratiroid

Ethical Statement

In compliance with the Declaration of Helsinki, our Institutional Non-Interventional Clinical Research Ethics Committee approved the study (Approval no:0567, 22/12/2022)

Project Number

0567

Retrospective Evaluation of Surgical Indications in Patients Presenting with Asymptomatic Primary Hyperparathyroidism: Single-Center Experience

Abstract

Objective: Primary hyperparathyroidism (PHPT) has evolved from a historically symptomatic disease to a predominantly asymptomatic condition, owing to advances in biochemical screening. This study delves into the retrospective evaluation of surgical indications and outcomes in asymptomatic PHPT patients, exploring the shift in disease presentation and the increasing incidence attributed to varied factors.
Materials and Methods: A review of asymptomatic PHPT cases diagnosed between January 2017-2022 was conducted at the Department of Endocrinology and Metabolism in Izmir Katip Celebi University, Atatürk Training and Research Hospital; surgical indications were assessed based on criteria outlined in the 4th International Workshop Asymptomatic PHPT guidelines.
Results: Among 48 patients (98% female, mean age 54.9 ± 5.9), 56.2% exhibited at least one surgical indication, with osteoporosis and renal complications being the most prevalent.
Conclusion: The study addresses the cautious approach to recommending parathyroidectomy in mild PHPT cases, emphasizing the criteria established by the 4th International Workshop. Contrary to the absence of long-term randomized research, recent meta-analyses and observational studies reveal limited changes in fracture rates, bone mineral density, nephrolithiasis, cardiovascular events, and quality of life. The debate over surgery benefits in non-surgical long-term follow-up remains to be conclusive. The study contributes valuable insights into the evolving landscape of surgical decision-making, emphasizing the need for further research on the long-term benefits and risks associated with surgery in this patient population. This retrospective analysis seeks to enhance our understanding of surgical interventions for asymptomatic PHPT and guide future clinical practices.

Keywords

Primary hyperparathyroidism, hypercalcemia, parathyroid

Ethical Statement

In compliance with the Declaration of Helsinki, our Institutional Non-Interventional Clinical Research Ethics Committee approved the study (Approval no:0567, 22/12/2022)

Project Number

0567

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