Clinical, diagnosis, localization studies and treatment in primary hyperparathyroidism

Yıl 2018, Cilt: 15 Sayı: 2, 40 - 44, 14.08.2018

Ayetullah Temiz Mustafa Suphi Turgut

Öz

Background: Primary hyperparathyroidism is an endocrine hormone disorder disease characterized by hypercalcemia with excessive secretion of parathyroid hormone from the parathyroid glands. The most common cause is parathyroid adenomas. Curative treatment is the surgery. In this study, we aimed to present the results of 47 patients operated for primary hyperparathyroidism

Material and Methods: Data of 47 patients who have been treated surgically with diagnosis of parathyroid adenoma between 2009 and 2017 were analyzed retrospectively.

Results: Forty 0ne patients were female, 6 were male and the mean age was 52.53 (range 21-76 years). The most common symptom patients was bone and joint pain with 21 patients. Preoperative mean PTH values were 381.8 (116-1348) pg / mL, mean Ca values 11.1 (9.7-14.2) mg / dL. The accuracy rate for pathologic parathyroid gland localization study was 75 % in neck USG, 85 % in parathyroid scintigraphy, and 40 % in neck CT. The mean PTH values measured at postoperative 12th hour were 84.1 (4-808.2) pg / ml and mean Ca values were 9.1 (6.7-12.35) mg / dl, whereas 36th hour were 83, 27 (4-435) pg / ml, Ca values 8.8 (7.3-12.19) mg / dl. Parathyroid the PTH values at postoperative Histopathology was parathyroid adenoma in 45 patients and parathyroid hyperplasia was in 2 patients. Thyroid surgery was performed in 18 patients because of accompanying thyroid disease Simultaneous. When thyroid histopathology was evaluated, 14 patients had adenomatous nodular goiter, 3 patients had thyroid papillary carcinoma, and 1 patient had thyroid medullary carcinoma. Complications were hypocalcemia in 3 patients.

Conclusion: Patients with symptomatic PHPT should be treated surgically in order to avoid long-term complications. Risky patients who are thought to develop complications in the future should be operated. In asymptomatic hyperparathyroidism patients. We recommended that parathyroid scintigraphy and neck ultrasonography are used together for preoperative localization. We evaluated that minimally invasive surgery is useful with a successful localization study.

Anahtar Kelimeler

Primary hyperparathyroidism, Hypercalcemia, Parathyroid adenoma

Primer hiperparatiroidizmde klinik, tanı, lokalizasyon çalışması ve tedavi

Öz

Amaç: Primer hiperparatiroidizm, paratiroid bezlerinin parathormonun aşırı salgılanması sonucu hiperkalsemi ile karakterize bir endokrin hormon bozukluğu hastalığıdır. Ensık sebep paratiroid adenomudur. Küratif tedavisi cerrahidir. Bu çalışmada primer hiperparatiroidizm nedeniyle ameliyat edilen 47 hastanın sonuçlarını literatür eşliğinde sunmayı amaçladık.

Materyal ve Metod: Eylül 2009 - Aralık 2017 yılları arasında Erzurum Bölge Eğitim ve Araştırma Hastanesi Genel Cerrahi Kliniğinde Primer hiperparatirodizm nedeniyle ameliyat edilen 47 hastanın arşiv dosyaları retrospektif olarak incelendi.

Bulgular: Hastaların 41’i kadın, 6’sı erkek olup yaş ortalaması 52,53 (21-76) idi. Hastalarda görülen en sık semptom 21 hasta ile kemik ve eklem ağrısı idi. En sık yandaş hastalık 5 hastada görülen ile hipertansiyon idi. Ameliyat öncesi ortalama PTH değerleri 381,8(116-1348) pg/ml, ortalama Ca değerleri 11,1 (9,7-14,2) mg/dl dir. Preoperatif tanı için 37 hastaya USG yapılmış 28 hastada doğru tanı konulmuş, 40 hastaya sintigrafi çekilmiş 34 hastaya doğru tanı konulmuş, 5 hastaya CT çekilmiş 2 hastaya doğru tanı konulmuştur. Postoperatif 12. saatte bakılan ortalama PTH değerleri 84,1(4-808,2) pg/ml, ortalama Ca değerleri 9,1(6,7-12,35) mg/dl iken postoperatif 36. Saatte bakılan PTH değerleri 83,27(4-435) pg/ml, Ca değerleri 8,8 (7,3-12,19) mg/dl idi. Histopatoloji olarak 45 hastada paratiroid adenomu 2 hastada ise paratiroid hiperplazi mevcuttu. Lokalizasyon olarak adenomların 23’ü sol alt, 5’i sol üst, 15’i sağ alt, 4’ü sağ üst tiroid lobu komşuluğunda idi. Hastaların 18’ inde ek yandaş tiroid hastalığı olduğu için eş zamanlı 13 hastaya total tiroidektomi, 5 hastaya da tek taraflı lobektomi yapıldı. Tiroidektomi sonrası histopatoloji değerlendirildiğinde 14 hastada adenomatöz ya da nodüler guatr, 3 hastada tiroid papiller karsinom, 1 hastada ise tiroid medüller karsinom görüldü. Komplikasyon olarak 3 hastada hipokalsemi gelişti.

Sonuç: Uzun dönem komplikasyonlarından korunmak için semptomatik primer paratiroidili hastaların tümü cerrahi olarak tedavi edilmelidir. Asemptomatik hiperparatiroidili hastalarda ise ileri dönemde komplikasyon gelişebileceği düşünülen riskli hastalar ameliyat edilmelidir. Ameliyat öncesi lokalizasyon için paratiroid sintigrafisi ve boyun ultrasonografisinin birlikte kullanılmasını önermekteyiz. Başarılı bir lokalizasyon çalışması ile minimal invaziv cerrahi girişimin faydalı olacağını değerlendirmekteyiz.

Anahtar Kelimeler

Primer hiperparatiroidizm, Hiperkalsemi, Paratiroid adenomu

Kaynakça

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