| Purpose:To analyze the clinical features and changes of primary hyperparathyroidism(PHPT)in China,and explore the differences of clinical characteristics of primary hyperparathyroidism between our country and the west and its possible causes.Further more,to improve the ability of clinicians to diagnose and recognize PHPT.Methods:Retrospective analysis the clinical features of PHPT patients admitted to the first affiliated hospital of dalian medical university from 2000 to 2017,including the age of onset,course of disease,clinical manifestation,initial symptoms,first diagnosis department,pathology,auxiliary examination results,etc.Compare the clinical differences between the two PHPT patients from 2000 to 2010 and from 2011 to 2017;For PHPT patients from 2000 to 2017,the clinical biochemical data were compared and analyzed by pathological type.Results:1.Totally 36 cases of PHPT were collected,among them 14 cases were males,22 cases were female,14 cases were diagnosed with surgical treatment and 22 were not operated.Among the patients treated with surgery,13 were parathyroid adenomas(92.86%),of which 6 were adenomas on the right side(42.86%)and 7 cases were left adenomas(50%).Two cases were parathyroid hyperplasia(14.28%),one of them was parathyroid hyperplasia combined with parathyroid adenoma(7.14%).In no surgical treatment of the patients,by imaging examination,13 cases were considered parathyroid adenoma(59.09%),5 cases were parathyroid hyperplasia(22.72%),1 case was parathyroid adenoma with parathyroid hyperplasia(4.5%),1 case was parathyroid carcinoma(4.5%),2 cases have no imaging examination,the cause is unknown.2.The onset age of PHPT patients was(57.31 ± 14.05)years(19 ~ 87 years).The mean age of the definitive diagnosis was(59.31 ± 14.37)and the onset of symptoms to a definite diagnosis was 0.25~20 months,and the median was 6 months.3.This group of patients with a wide range of first visit clinical departments,mainly including endocrinology,general surgery,neurology,gastroenterology dept.,general surgery,is rich in clinical manifestation,mainly including the performance of digestive system,nervous system,urinary system and skeletal system.15 patients with skeletal system performance(41.66%),16 cases with urinary system performance(44.44%),17 cases with digestive system performance(44.44%),13 patients with nervous system performance(36.11%),8 cases of asymptomatic(22.22%),the clinical manifestations were complex.4.The serum calcium was high in 35 cases,and the serum calcium in 1 case was in normal range,and the serum calcium average was(3.13 ± 0.42)mmol/L.The 36 cases showed low blood phosphorus and high PTH.The patients in this group had vitamin D deficiency,with an average of 25 OHD of(11.97 ± 6.58)ng/ml,an average of(6.78 ± 1.71)ng/ml in adenoma group,and an average of(16.77 ± 6.11)ng/ml in hyperplasia group.5.PHPT patients diagnosed from 2000 to 2010 were compared with the patients from 2011 to 2017.There were 25 PHPT patients between 2011 and 2017.,12 cases with the performance of the skeletal system(48%),10 cases with urinary system performance(40.0%),9 cases had the performance of the digestive system(36.00%),6 cases had the performance of the nervous system(24.00%),5 cases with the performance of the skeletal system and urinary system(25%),8 cases of asymptomatic(32%),mean value of serum calcium was(3.07 ± 0.39)mmol/L.There were 11 PHPT patients between 2011 and 2017.3 cases with the performance of the skeletal system(27.27%),6 cases with urinary system performance(54.54%),7 cases had the performance of the digestive system(63.63%),7 cases had the performance of the nervous system(63%),3 cases with the performance of the skeletal system and urinary system(27.27%),1 cases of asymptomatic(9.09%),mean value of serum calcium was(3.26 ± 0.46)mmol/L.Compared with the patients in the previous 10 years,the number of patients increased,the proportion of renal type decreased,the proportion of bone type increased,and the proportion of asymptomatic types increased.Conclusion:1.The PHPT patients in this region are mostly middle-aged and elderly,with a avariety of first symptoms.The traditional primary hyperparathyroidism is the main clinical manifestation,different from western countries with asymptomatic clinical manifestations.2.The lack of extensive screening for blood calcium and phosphorus may lead to the serious condition of PHPT patients in China when they are diagnosed,which may be the main reason for the obvious difference between the clinical manifestations of PHPT patients and those in western countries.3.The increase in the proportion of asymptomatic patients with PHPT in recent seven years may be related to the popularization of blood calcium and phosphorus screening in our hospital in recent years. |
PDF Full Text Request