원발성부갑상선 기능항진증의 임상적 고찰 (Clinical evaluation of primary hyperparathyroidism)

서지정보

· 발행기관 : 고신대학교(의대) 고신대학교 의과대학 학술지
· 수록지 정보 : 고신대학교 의과대학 학술지 / 21권 / 2호 / 199 ~ 205페이지
· 저자명 : 류동원, 김정훈

초록

Background : The purpose of this study is to evaluate the clinical characteristics of patients with primary hyperparathyroidism by a retrospective analysis of their medical records. Primary hyperparathyroidism is a relatively frequent disease in western countries. The rate of occurrence in Korea is increasing due to increased concern of people and the development of imaging techniques. Primary hyperparathyroidism if the most frequent cause of hypercalcemia and due to the routine examination of serum calcium levels, the number of patients with primary hyperparathyroidism has increased.
Methods : We reviewed 10 patients treated by surgery over the 5-year period at the Kosin University Hospital and retrospectively analyzed both the clinicopathologic and bio-chemical features of the presented cases and the effective methods of treatment and diagnosis retrospectively.
Results : 10 patients with symptomatic hyperparathyroidism underwent a parathyoidectomy from Jan.1999 to Dec.2003 at the Department of Surgery, Kosin University Hospital. The mean age of the patients was 47.6 years old and the male-to-female ratio is 4:6. The most common presenting clinical manifestation were associated with neck palpable mass in 60%, and general weakness in 40%, and bone pain in 20%, and recurrent urinary stone in 20%, and asymptomatic in 20%. The mean duration of the major symptom of hyperparathyroidism was 10.3 months. The level of preoperative serum calcium was 13.6 mg and the level of serum parathyroid hormone was greatly greatly higher than the standard value of hospital laboratory. Preoperative localization study was performed with ultrasonography (USG), computed tonography (CT), Methoxylisobutyl isonitrile (MIBI) scan. The pathologic types of the enlarged glands were adenomas (8 cases) and parathyroid carcinoma (2 cases). The mean size of the parathyroid tumors was 2.14 cm and the mean weight was 4.7 gram. Postoperative hypocalcemia developed in 9 patients and was the most severe on postoperative 3rd day. All patients showed hypercalcemia and the serum parathyroid hormone (PTH) level was elevated in all 10 patients after 1999. Transient hypocalcemia following surgery occurred in 9 patients and they were treated with calcium. There were no recurrent cases with the exception of one who displayed carcinoma.
Conclusion : There was 10.3 months interval from the onset of patients symptoms to the time of parathyroidectomy. Endocrine surgeons should pursue detecting the operable parathyroid tumors and remind medical endocrinologists that the best way of localizing parathyroid tumors is through an operation. In the study, most of the patients were discovered with an advanced clinical and biochemical status but the number of the asymptomatic patients is increasing. Through an accurate preoperative localization, they were successfully treated with parathyroidectomy without major complication.

영어초록

Background : The purpose of this study is to evaluate the clinical characteristics of patients with primary hyperparathyroidism by a retrospective analysis of their medical records. Primary hyperparathyroidism is a relatively frequent disease in western countries. The rate of occurrence in Korea is increasing due to increased concern of people and the development of imaging techniques. Primary hyperparathyroidism if the most frequent cause of hypercalcemia and due to the routine examination of serum calcium levels, the number of patients with primary hyperparathyroidism has increased.
Methods : We reviewed 10 patients treated by surgery over the 5-year period at the Kosin University Hospital and retrospectively analyzed both the clinicopathologic and bio-chemical features of the presented cases and the effective methods of treatment and diagnosis retrospectively.
Results : 10 patients with symptomatic hyperparathyroidism underwent a parathyoidectomy from Jan.1999 to Dec.2003 at the Department of Surgery, Kosin University Hospital. The mean age of the patients was 47.6 years old and the male-to-female ratio is 4:6. The most common presenting clinical manifestation were associated with neck palpable mass in 60%, and general weakness in 40%, and bone pain in 20%, and recurrent urinary stone in 20%, and asymptomatic in 20%. The mean duration of the major symptom of hyperparathyroidism was 10.3 months. The level of preoperative serum calcium was 13.6 mg and the level of serum parathyroid hormone was greatly greatly higher than the standard value of hospital laboratory. Preoperative localization study was performed with ultrasonography (USG), computed tonography (CT), Methoxylisobutyl isonitrile (MIBI) scan. The pathologic types of the enlarged glands were adenomas (8 cases) and parathyroid carcinoma (2 cases). The mean size of the parathyroid tumors was 2.14 cm and the mean weight was 4.7 gram. Postoperative hypocalcemia developed in 9 patients and was the most severe on postoperative 3rd day. All patients showed hypercalcemia and the serum parathyroid hormone (PTH) level was elevated in all 10 patients after 1999. Transient hypocalcemia following surgery occurred in 9 patients and they were treated with calcium. There were no recurrent cases with the exception of one who displayed carcinoma.
Conclusion : There was 10.3 months interval from the onset of patients symptoms to the time of parathyroidectomy. Endocrine surgeons should pursue detecting the operable parathyroid tumors and remind medical endocrinologists that the best way of localizing parathyroid tumors is through an operation. In the study, most of the patients were discovered with an advanced clinical and biochemical status but the number of the asymptomatic patients is increasing. Through an accurate preoperative localization, they were successfully treated with parathyroidectomy without major complication.

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