Abstract：
Cure after surgery for normocalcemic primary hyperparathyroidism (NHPT) is defined as parathyroid hormone (PTH) normalization. However, an increase of PTH is frequently observed in cured patients with hypercalcemic primary hyperparathyroidism (HHPT). Therefore, this criterion must be redefined. A single-center retrospective study was performed including all patients who underwent surgery for Primary Hyperparathyroidism from 2013 to 2019. Cure rates of different types of hyperparathyroidism were analyzed. PTH reduction was studied as a possible criterion to define cure in patients with NHPT. One-hundred and eighty-six patients were included: 173 with HHPT and 13 with NHPT. After a mean follow-up of 33.4 months, 174 (93.6%) patients were considered cured. Cure was more frequent in the group of patients with HHPT (97.1% vs. 46.2%, p < 0.001). In the multivariate analysis, surgical failure was associated with NHPT and multiglandular disease. Forty-nine (30.1%) cured patients with HHPT had an increased PTH during the follow-up. When decline of PTH levels was studied in patients with HHPT to define cure, the area under curve was 0.92. A cut-off value of 40% in PTH reduction achieved a sensitivity and specificity of 83.4% and 80.0%. If cure was defined as a 40% reduction of PTH, cure rate in the group of patients with NHPT would increase to 69.2%. Patients with NHPT had a lower cure rate than patients with HHPT. A significant number of cured patients with HHPT had an increased PTH during follow-up. A 40% reduction in PTH levels is proposed as an alternative definition for cure in patients with NHPT.
摘要：
手术后正常血钙原发性甲状旁腺功能亢进（NHPT）的治愈定义为甲状旁腺激素（PTH）正常化。然而,在患有高钙血症性原发性甲状旁腺功能亢进（HHPT）的治愈患者中，经常观察到PTH增加。因此,这个标准必须重新定义。进行了一项单中心回顾性研究，包括2013年至2019年接受原发性甲状旁腺功能亢进症手术的所有患者。分析不同类型甲状旁腺功能亢进的治愈率。研究了PTH减少作为定义NHPT患者治愈的可能标准。纳入了186例患者：173例HHPT和13例NHPT。经过33.4个月的平均随访，174例（93.6%）患者被认为治愈。HHPT患者组的治愈频率更高（97.1％vs.46.2%,p<0.001)。在多变量分析中，手术失败与NHPT和多腺体疾病有关.在随访期间，有49例（30.1％）治愈的HHPT患者的PTH增加。当研究HHPT患者的PTH水平下降以确定治愈时，曲线下面积为0.92.PTH减少的40%的截断值实现了83.4%和80.0%的灵敏度和特异性。如果治愈定义为PTH减少40%,NHPT患者组的治愈率将提高到69.2%。NHPT患者的治愈率低于HHPT患者。在随访期间，大量治愈的HHPT患者的PTH增加。建议将PTH水平降低40％作为NHPT患者治愈的替代定义。
