| Primary hyperparathyroidism(PHPT)has become the third most common endocrine disease with the improvement of medical techniques.In western countries most patients with PHPT are asymptomatic,which is differ from our country in which the patients with PHPT are symptomatic.However recently,the rate of our asymptomatic hyperparathyroidism(aPHPT)patients also showed a upward trend.Although asymptomatic hyperparathyroidism present no obvious clinical symptoms,there are still bone destruction,kidney damage and other complications.Objective: Our objective was to describe the clinical patterns of asympotomatic and symptomatic PHPT patients in our department from 2012 to 2016.Methods: A total of 113 patients who were diagnosed as primary hyperparathyroidism during 2012 to 2016 in Department of Endocrinology,Tianjin Medical University General Hospital were studied.The clinical manifestations and biochemical abnormalities of these patients were analysed.Results:(1)The number of patients who visited our department and were diagnosed with primary hyperparathyroidism from 2012 to 2016 increased year by year.In 2012,12 patients were diagnosed with primary hyperparathyroidism and 3 were asymptomatic,accounting for 25% of the same period;while this number was increased to 39.39% in 2016.(2)Comparing the biochemical features in asymptomatic and symptomatic patients with PHPT,there were significantly statistical differences on serum parathyroid hormone(PTH)and serum calcium between the two groups(p<0.05).The average PTH of aPHPT was 35.10(21.70-66.90)pmol/L while cPHPT was 62.10(28.00-138.00)pmol/L.The serum calcium of aPHPT was 2.80(2.73-2.97)while the serum calcium of cPHPT was 3.00(2.79-3.44)mmol/L.(3)Adenoma was the most common pathological type in both aPHPT and cPHPT patients,but the incidence of malignant tumors in the aPHPT was lower than that of cPHPT groups.(4)There was still a certain degree of bone destruction in aPHPT patients.The bone density of the lumbar spine in the aPHPT group and the cPHPT group were(0.92±0.19)g/cm 2,(0.87±0.19)g/cm 2;and the femur Neck bone density of the two groups were(0.74 ± 0.12)g/cm2 and(0.66 ±0.26)g/cm2,respectively,with no significant difference between the groups(p>0.05).There were also significant differences in bone turnover markers including osteoarthritis(OC),type I procollagen N-terminal propeptide(PINP),type I collagen C-terminal peptide(CTX),and serum alkaline phosphatase(ALKP)in both groups(p<0.05),the degree of bone turnover in the cPHPT group was significantly higher than that of the asymptomatic group.(5)23.53% of aPHPT patients were found with urinary calculi,while 26.58% in symptomatic groups.There was no significant difference between this two groups(p>0.05).(6)It's common that PHPT patients were accompanied with 25(OH)VD deficiency.The levels of 25(OH)VD in the aPHPT and cPHPT were 48.41(34.42-76.02)nmol/L and 25.47(20.86-36.53)nmol/L,respectively.There was a significant difference between the two groups(p<0.001).(7)We also analysis their triglyceride,cholesterin and fasting blood glucose.There was a significant difference on elevated triglyceride levels between the two groups(p<0.05)The triglyceride in the cPHPT group were significantly higher than that in the aPHPT.(8)According to the quartiles of PTH levels,there were statistically significant differences in serum calcium,phosphorus,25(OH)VD,bone turnover index,and bone mineral density at the lumbar spine;while according to the quartile of 25(OH)VD levels,only bone turnover was found.There are differences among the indicators in the groups,while the other indicators do not show significant statistical differences.Conclusion:(1)Both the proportion of asymptomatic hyperparathyroidism and total primary hyperparathyroidism in our department are increasing year by year.(2)The aPHPT patients have differences in serum PTH level,serum calcium and urinal calcium with cPHPT.The cPHPT patients showed more severe abnormalities in laboratory tests.Adenoma was the majority pathological type in both the two groups,and the incidence of malignancy in the aPHPT group was lower than that in the cPHPT group.(3)Asymptomatic hyperparathyroidism patients also have a high degree of bone destruction,and the bone resorption in areas with high level of cortical bone seems more sever than that with more cancellous bone.This is same with that of the cPHPT group.(4)Serum PTH levels,serum calcium levels,and25(OH)VD levels affect the development of primary hyperparathyroidism in patients with classic symptoms,but 25(OH)VD levels do not affect the severity of the disease. |
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