Hyperparathyroidism nguyên phát

Springer Science and Business Media LLC - Tập 1 - Trang 25-34 - 2002
John P. Bilezikian1, Shonni J. Silverberg1
1Department of Medicine, College of Physicians and Surgeons, Columbia University, New York

Tóm tắt

Những mô tả lâm sàng sớm nhất về hyperparathyroidism nguyên phát chỉ ra rằng đây là một rối loạn tiến triển không thể tránh khỏi. Hiện tại, ở những cá nhân không có triệu chứng và không đáp ứng các hướng dẫn phẫu thuật, hyperparathyroidism nguyên phát, nhìn chung, không có vẻ gì là sẽ tiến triển. Các bệnh nhân không có triệu chứng có xu hướng giữ nguyên trạng thái không triệu chứng trong nhiều năm quan sát. Đối với những người có biểu hiện lâm sàng rõ rệt, sỏi thận là lý do phổ biến nhất. Đối với những bệnh nhân này, phẫu thuật rõ ràng là cần thiết. Đo mật độ xương là một thành phần không thể thiếu trong việc đánh giá cũng như theo dõi, vì có bằng chứng cho thấy xương bị ảnh hưởng bởi công nghệ này ở hầu hết các bệnh nhân. Điều này trái ngược với chụp X-quang xương, thường luôn có kết quả âm tính. Tuy nhiên, chỉ những bệnh nhân không bình thường mới cho thấy một phép đo khối lượng xương tại xương vỏ hoặc xương xốp có giá trị thấp hơn hai độ lệch chuẩn so với nhóm chứng cùng độ tuổi và giới tính. Những cá nhân như vậy vẫn nên được khuyến nghị thực hiện phẫu thuật cận giáp. Mật độ xương, nồng độ canxi huyết thanh và/hoặc lượng canxi bài tiết qua nước tiểu có thể cho thấy bằng chứng tiến triển trong khoảng 25% bệnh nhân bị hyperparathyroidism nguyên phát không có triệu chứng. Vì lý do này, tất cả các bệnh nhân không dự kiến phẫu thuật cho hyperparathyroidism nguyên phát nên được theo dõi với việc xét nghiệm định kỳ hai năm một lần (nồng độ canxi huyết thanh) hoặc hàng năm (bài tiết canxi qua nước tiểu và đo mật độ xương).

Từ khóa

#hyperparathyroidism nguyên phát #sỏi thận #mật độ xương #nồng độ canxi huyết thanh #bài tiết canxi qua nước tiểu

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