PDF(Pubmed)
Abstract：
Primary hyperparathyroidism (PHPT) is classically characterized by hypercalcemia with elevated or inappropriately normal parathyroid hormone (PTH) levels. Elevated PTH levels in the presence of normal calcium levels are not infrequently found during the evaluation of metabolic bone disorders or kidney stone disease. This can be caused by secondary hyperparathyroidism (SHPT) or normocalcemic primary hyperparathyroidism (NPHPT). NPHPT is due to autonomous parathyroid function whereas SHPT is caused by a physiologic stimulation to PTH secretion. Many medical conditions and medications can contribute to SHPT, and differentiation between SHPT and NPHPT may be difficult. Cases are presented to illustrate examples. In this paper, we review the distinction between SHPT and NPHPT as well as end organ effects of NPHPT and outcomes of surgery in NPHPT. We suggest that the diagnosis of NPHPT be made only after careful exclusion of causes of SHPT and consideration of medications that can increase PTH secretion. Further, we advise a conservative approach to surgery in NPHPT.
摘要：
原发性甲状旁腺功能亢进（PHPT）的典型特征是高钙血症，甲状旁腺激素（PTH）水平升高或异常正常。在代谢骨病或肾结石疾病的评估过程中，在正常钙水平存在下PTH水平升高并不罕见。这可能是由继发性甲状旁腺功能亢进（SHPT）或正常血钙原发性甲状旁腺功能亢进（NPHPT）引起的。NPHPT是由于自主甲状旁腺功能,而SHPT是由对PTH分泌的生理刺激引起的。许多医疗条件和药物可以有助于SHPT，SHPT和NPHPT之间的区别可能很困难。提供案例来说明示例。在本文中,我们回顾了SHPT和NPHPT之间的区别以及NPHPT的最终器官效应和NPHPT手术的结局。我们建议只有在仔细排除SHPT的原因并考虑可以增加PTH分泌的药物后，才能诊断NPHPT。Further,我们建议采用保守的NPHPT手术方法。
