Clinical Analysis And Follow-up Of Primary Hyperparathyroidism

ObjectivesTo analyze the clinical characteristics,diagnosis,treatment methods,pathological types and the clinical manifestation changes of primary hyperparathyroidism(PHPT)in Qilu hospital,and to follow up the therapeutic effects with or without surgery.MethodsThis was a retrospective analysis involving 317 patients with primary hyperparathyroidism in Qilu hospital of Shandong university between Nov 2003 and Dec 2018.We collected the general situation,clinical manifestations,examinations,surgical data and pathological type of patients and follow up treatment effects including postoperative examinations and recurrence,using the SPSS(version 24.0)for analysis.ResultsThere were 317 PHPT patients admitted to our hospital,110 male patients and 207 female patients,with a male to female ratio of 1:1.88.Mean onset age was(52.18±12.85)years.The most frequent symptoms were skeletal manifestations,with 82 cases(39.0%).76 cases(36.2%)presented with urinary symptoms.41 patients were misdiagnosed,with an average course of(41.61±53.97)months.90 PHPT patients performed bone mineral density examination during hospitalization.107 cases(33.8%)presented with asymptomatic hyperparathyroidism(APHPT).Asymptomatic patients increased from 24 cases(24/108,22.2%)in 2003-2013 to 83 cases(83/209,39.7%)in 2014-2018.The biochemical and bone turnover makers in patients with APHPT were superior to patients with symptomatic primary hyperparathyroidism.279 patients underwent parathyroidectomy.The postoperative pathology showed 242 cases of parathyroid adenoma,1 case of parathyroid hyperplasia,24 cases of parathyroid cyst and 8 cases of parathyroid carcinoma.The positive rate of cervical ultrasound and 99mTc-MIBI for preoperative localization were 87.5%?92.7%respectively.Among 159 PHPT patients who were followed up after surgery,18 patients presented with recurrence,accounting for 11.3%,and 2 patients had postoperative complications,accounting for 1.3%.ConclusionsThe first-visit medical departments and clinical manifestations of patients with PHPT were quite various,which contributed to miss and delay diagnosis easily.The cervical ultrasound and 99mTc-MIBI had relatively high positive rate of for preoperative localization,A changing pattern of PHPT from symptomatic to asymptomatic and mild in the study has been demonstrated.Among PHPT patients,bone mineral density examination was not universal.In addition,PHPT patients had poor postoperative compliance and many patients interrupted the postoperative review by themselves,which needed clinicians pay more attention to.