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

Yıl 2024, Cilt: 4 Sayı: 2, 9 - 16, 31.08.2024

Öz

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.

Etik Beyan

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

Proje Numarası

0567

Kaynakça

  • Albright F., Recfenstein EC. The parathyroid glands and metabolic bone disease. Ulster Med J 1950; 19(1):130-1.
  • Eastell R., Arnold A., Brandi ML., et al. Diagnosis of asymptomatic primary hyperparathyroidism: Proceedings of the third international workshop. J Clin Endocrinol Metab 2009; 94(2):340–50. Doi: 10.1210/jc.2008-1758.
  • Adami S., Marcocci C., Gatti D. Epidemiology of primary hyperparathyroidism in Europe. J Bone Miner Res 2002;17(Suppl 2):N18-23.
  • Bilezikian JP., Bandeira L., Khan A., Cusano NE. Hyperparathyroidism. Lancet 2018; 391(10116):168–78. Doi:10.1016/S0140-6736(17)31430-7.
  • Minisola S., Arnold A., Belaya Z., et al. Epidemiology, pathophysiology, and genetics of primary hyperparathyroidism. J Bone Miner Res 2022; 37(11):2315-29. Doi: 10.1002/jbmr.4665.
  • Bilezikian JP., Cusano NE., Khan AA., Liu JM., Marcocci C., Bandeira F. Primary hyperparathyroidism. Nat Rev Dis Prim 2016; 2:1–16. Doi: 10.1038/NRDP.2016.33.
  • Mack LA., Pasieka JL. Asymptomatic primary hyperparathyroidism: A surgical perspective. Surg Clin North Am 2004; 84(3):803-16. Doi: 10.1016/j.suc.2004.01.004.
  • Rubin MR., Bilezikian JP., McMahon DJ., et al. The natural history of primary hyperparathyroidism with or without parathyroid surgery after 15 years. J Clin Endocrinol Metab 2008; 93(9):3462-70. Doi: 10.1210/jc.2007-1215.
  • Makras P., Anastasilakis AD. Bone disease in primary hyperparathyroidism. Metabolism 2018; 80:57–65. Doi: 10.1016/j.metabol.2017.10.003.
  • Bilezikian JP., Brandi ML., Eastell R., et al. Guidelines for the management of asymptomatic primary hyperparathyroidism: summary statement from the Fourth International Workshop. J Clin Endocrinol Metab 2014; 99(10):3561–9. Doi: 10.1210/JC.2014-1413.
  • Singh Ospina N., Maraka S., Rodriguez-Gutierrez R., et al. Comparative efficacy of parathyroidectomy and active surveillance in patients with mild primary hyperparathyroidism: A systematic review and meta-analysis. Osteoporos Int 2016; 27(12):3395–407. Doi: 10.1007/S00198-016-3715-3.
  • Lowe H., McMahon DJ., Rubin MR., Bilezikian JP., Silverberg SJ. Normocalcemic primary hyperparathyroidism: further characterization of a new clinical phenotype. J Clin Endocrinol Metab 2007; 92(8):3001–5. Doi: 10.1210/JC.2006-2802.
  • Kontogeorgos G., Trimpou P., Laine CM., Oleröd G., Lindahl A., Landin-Wilhelmsen K. Normocalcaemic, vitamin D-sufficient hyperparathyroidism - high prevalence and low morbidity in the general population: A long-term follow-up study, the WHO MONICA project, Gothenburg, Sweden. Clin Endocrinol 2015; 83(2):277–84. Doi: 10.1111/CEN.12819.
  • García-Martín A., Reyes-García R., Muñoz-Torres M. Normocalcemic primary hyperparathyroidism: one-year follow-up in one hundred postmenopausal women. Endocrine 2012; 42(3):764–6. Doi: 10.1007/S12020-012-9694-Z.
  • Silverberg SJ., Lewiecki EM., Mosekilde L., Peacock M., Rubin MR. Presentation of asymptomatic primary hyperparathyroidism: Proceedings of the third international workshop. J Clin Endocrinol Metab 2009; 94(2):351-65. Doi: 10.1210/jc.2008-1760.
  • Christiansen P., Steiniche T., Mosekilde L., Hessov I., Melsen F. Primary hyperparathyroidism: changes in trabecular bone remodeling following surgical treatment--evaluated by histomorphometric methods. Bone 1990; 11(2):75–9. Doi: 10.1016/8756-3282(90)90053-2.
  • Wermers RA., Khosla S., Atkinson EJ., et al. Survival after the diagnosis of hyperparathyroidism: A population-based study. Am J Med 1998; 104(2):115–22. Doi: 10.1016/S0002-9343(97)00270-2.
  • Pretorius M., Lundstam K., Heck A., et al. Mortality and morbidity in mild primary hyperparathyroidism: Results from a 10-year prospective randomized controlled trial of parathyroidectomy versus observation. Ann Intern Med 2022; 175(6):812–9. Doi: 10.7326/M21-4416.
  • Yeh MW., Wiseman JE., Ituarte PH., et al. Surgery for primary hyperparathyroidism: Are the consensus guidelines being followed? Ann Surg 2012 Jun;255(6):1179-83. Doi: 10.1097/SLA.0b013e31824dad7d.
  • Silverberg SJ., Shane E., Jacobs TP., Siris E., Bilezikian JP. A 10-year prospective study of primary hyperparathyroidism with or without parathyroid surgery. N Engl J Med 1999; 341(17):1249–55. Doi: 10.1056/NEJM199910213411701.

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

Yıl 2024, Cilt: 4 Sayı: 2, 9 - 16, 31.08.2024

Öz

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.

Etik Beyan

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

Proje Numarası

0567

Kaynakça

  • Albright F., Recfenstein EC. The parathyroid glands and metabolic bone disease. Ulster Med J 1950; 19(1):130-1.
  • Eastell R., Arnold A., Brandi ML., et al. Diagnosis of asymptomatic primary hyperparathyroidism: Proceedings of the third international workshop. J Clin Endocrinol Metab 2009; 94(2):340–50. Doi: 10.1210/jc.2008-1758.
  • Adami S., Marcocci C., Gatti D. Epidemiology of primary hyperparathyroidism in Europe. J Bone Miner Res 2002;17(Suppl 2):N18-23.
  • Bilezikian JP., Bandeira L., Khan A., Cusano NE. Hyperparathyroidism. Lancet 2018; 391(10116):168–78. Doi:10.1016/S0140-6736(17)31430-7.
  • Minisola S., Arnold A., Belaya Z., et al. Epidemiology, pathophysiology, and genetics of primary hyperparathyroidism. J Bone Miner Res 2022; 37(11):2315-29. Doi: 10.1002/jbmr.4665.
  • Bilezikian JP., Cusano NE., Khan AA., Liu JM., Marcocci C., Bandeira F. Primary hyperparathyroidism. Nat Rev Dis Prim 2016; 2:1–16. Doi: 10.1038/NRDP.2016.33.
  • Mack LA., Pasieka JL. Asymptomatic primary hyperparathyroidism: A surgical perspective. Surg Clin North Am 2004; 84(3):803-16. Doi: 10.1016/j.suc.2004.01.004.
  • Rubin MR., Bilezikian JP., McMahon DJ., et al. The natural history of primary hyperparathyroidism with or without parathyroid surgery after 15 years. J Clin Endocrinol Metab 2008; 93(9):3462-70. Doi: 10.1210/jc.2007-1215.
  • Makras P., Anastasilakis AD. Bone disease in primary hyperparathyroidism. Metabolism 2018; 80:57–65. Doi: 10.1016/j.metabol.2017.10.003.
  • Bilezikian JP., Brandi ML., Eastell R., et al. Guidelines for the management of asymptomatic primary hyperparathyroidism: summary statement from the Fourth International Workshop. J Clin Endocrinol Metab 2014; 99(10):3561–9. Doi: 10.1210/JC.2014-1413.
  • Singh Ospina N., Maraka S., Rodriguez-Gutierrez R., et al. Comparative efficacy of parathyroidectomy and active surveillance in patients with mild primary hyperparathyroidism: A systematic review and meta-analysis. Osteoporos Int 2016; 27(12):3395–407. Doi: 10.1007/S00198-016-3715-3.
  • Lowe H., McMahon DJ., Rubin MR., Bilezikian JP., Silverberg SJ. Normocalcemic primary hyperparathyroidism: further characterization of a new clinical phenotype. J Clin Endocrinol Metab 2007; 92(8):3001–5. Doi: 10.1210/JC.2006-2802.
  • Kontogeorgos G., Trimpou P., Laine CM., Oleröd G., Lindahl A., Landin-Wilhelmsen K. Normocalcaemic, vitamin D-sufficient hyperparathyroidism - high prevalence and low morbidity in the general population: A long-term follow-up study, the WHO MONICA project, Gothenburg, Sweden. Clin Endocrinol 2015; 83(2):277–84. Doi: 10.1111/CEN.12819.
  • García-Martín A., Reyes-García R., Muñoz-Torres M. Normocalcemic primary hyperparathyroidism: one-year follow-up in one hundred postmenopausal women. Endocrine 2012; 42(3):764–6. Doi: 10.1007/S12020-012-9694-Z.
  • Silverberg SJ., Lewiecki EM., Mosekilde L., Peacock M., Rubin MR. Presentation of asymptomatic primary hyperparathyroidism: Proceedings of the third international workshop. J Clin Endocrinol Metab 2009; 94(2):351-65. Doi: 10.1210/jc.2008-1760.
  • Christiansen P., Steiniche T., Mosekilde L., Hessov I., Melsen F. Primary hyperparathyroidism: changes in trabecular bone remodeling following surgical treatment--evaluated by histomorphometric methods. Bone 1990; 11(2):75–9. Doi: 10.1016/8756-3282(90)90053-2.
  • Wermers RA., Khosla S., Atkinson EJ., et al. Survival after the diagnosis of hyperparathyroidism: A population-based study. Am J Med 1998; 104(2):115–22. Doi: 10.1016/S0002-9343(97)00270-2.
  • Pretorius M., Lundstam K., Heck A., et al. Mortality and morbidity in mild primary hyperparathyroidism: Results from a 10-year prospective randomized controlled trial of parathyroidectomy versus observation. Ann Intern Med 2022; 175(6):812–9. Doi: 10.7326/M21-4416.
  • Yeh MW., Wiseman JE., Ituarte PH., et al. Surgery for primary hyperparathyroidism: Are the consensus guidelines being followed? Ann Surg 2012 Jun;255(6):1179-83. Doi: 10.1097/SLA.0b013e31824dad7d.
  • Silverberg SJ., Shane E., Jacobs TP., Siris E., Bilezikian JP. A 10-year prospective study of primary hyperparathyroidism with or without parathyroid surgery. N Engl J Med 1999; 341(17):1249–55. Doi: 10.1056/NEJM199910213411701.
Toplam 20 adet kaynakça vardır.

Ayrıntılar

Birincil Dil İngilizce
Konular Endokrinoloji
Bölüm Araştırma Makalesi
Yazarlar

Derya Sema Yaman Kalender

Mehmet Sercan Erturk 0000-0002-0411-553X

Proje Numarası 0567
Yayımlanma Tarihi 31 Ağustos 2024
Gönderilme Tarihi 20 Şubat 2024
Kabul Tarihi 1 Ağustos 2024
Yayımlandığı Sayı Yıl 2024 Cilt: 4 Sayı: 2

Kaynak Göster

APA Yaman Kalender, D. S., & Erturk, M. S. (2024). Retrospective Evaluation of Surgical Indications in Patients Presenting with Asymptomatic Primary Hyperparathyroidism: Single-Center Experience. Güncel Tıbbi Araştırmaları Dergisi, 4(2), 9-16. https://doi.org/10.52818/cjmr.1440317
AMA Yaman Kalender DS, Erturk MS. Retrospective Evaluation of Surgical Indications in Patients Presenting with Asymptomatic Primary Hyperparathyroidism: Single-Center Experience. GÜTAD. Ağustos 2024;4(2):9-16. doi:10.52818/cjmr.1440317
Chicago Yaman Kalender, Derya Sema, ve Mehmet Sercan Erturk. “Retrospective Evaluation of Surgical Indications in Patients Presenting With Asymptomatic Primary Hyperparathyroidism: Single-Center Experience”. Güncel Tıbbi Araştırmaları Dergisi 4, sy. 2 (Ağustos 2024): 9-16. https://doi.org/10.52818/cjmr.1440317.
EndNote Yaman Kalender DS, Erturk MS (01 Ağustos 2024) Retrospective Evaluation of Surgical Indications in Patients Presenting with Asymptomatic Primary Hyperparathyroidism: Single-Center Experience. Güncel Tıbbi Araştırmaları Dergisi 4 2 9–16.
IEEE D. S. Yaman Kalender ve M. S. Erturk, “Retrospective Evaluation of Surgical Indications in Patients Presenting with Asymptomatic Primary Hyperparathyroidism: Single-Center Experience”, GÜTAD, c. 4, sy. 2, ss. 9–16, 2024, doi: 10.52818/cjmr.1440317.
ISNAD Yaman Kalender, Derya Sema - Erturk, Mehmet Sercan. “Retrospective Evaluation of Surgical Indications in Patients Presenting With Asymptomatic Primary Hyperparathyroidism: Single-Center Experience”. Güncel Tıbbi Araştırmaları Dergisi 4/2 (Ağustos 2024), 9-16. https://doi.org/10.52818/cjmr.1440317.
JAMA Yaman Kalender DS, Erturk MS. Retrospective Evaluation of Surgical Indications in Patients Presenting with Asymptomatic Primary Hyperparathyroidism: Single-Center Experience. GÜTAD. 2024;4:9–16.
MLA Yaman Kalender, Derya Sema ve Mehmet Sercan Erturk. “Retrospective Evaluation of Surgical Indications in Patients Presenting With Asymptomatic Primary Hyperparathyroidism: Single-Center Experience”. Güncel Tıbbi Araştırmaları Dergisi, c. 4, sy. 2, 2024, ss. 9-16, doi:10.52818/cjmr.1440317.
Vancouver Yaman Kalender DS, Erturk MS. Retrospective Evaluation of Surgical Indications in Patients Presenting with Asymptomatic Primary Hyperparathyroidism: Single-Center Experience. GÜTAD. 2024;4(2):9-16.