[The short test with hydrochlorothiazide in differential diagnosis between primary normocalcemic and secondary hyperparathyroidism for inpatient treatment].

Q4 Medicine Problemy endokrinologii Pub Date : 2022-08-05 DOI:10.14341/probl13150
A K Eremkina, A R Elfimova, E A Aboisheva, E V Karaseva, M I Fadeeva, I S Maganeva, E V Kovaleva, A M Gorbacheva, E E Bibik, N G Mokrysheva
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Abstract

Background: Differential diagnosis between the normocalcemic primary hyperparathyroidism (nPHPT) and secondary hyperparathyroidism (SHPT) due to hypercalciuria remains a challenge.

Aim: The aim of this study was to investigate the capability of short test with hydrochlorothiazide for the differential diagnosis of nPHPT and SHPT.

Materials and methods: A retrospective study was conducted with the participation of 28 patients who underwent a functional test with thiazide diuretics during hospitalization in the Department of parathyroid glands pathology and mineral disorders of the Endocrinology Research Centre, Russia. Parameters of mineral metabolism were evaluated before and 3-5 days after taking hydrochlorothiazide 50 mg/day.

Results: According to baseline and dynamic biochemical evaluation patients were divided into 3 groups. Group 1 (n=21) included patients with confirmed PHPT, who reached hypercalcemia accompanying with an elevated level of iPTH (n=19) or an increased level of iPTH accompanying with normocalcemia (n=2). In group 1, baseline Caadj. was 2.48 mmol/l [2.47; 2.52], iPTH 107.5 pg/ml [86.8; 133.0], after short test - 2.63 mmol/l [2.59; 2.66] and 102.1 pg/ml [95,7; 124,1]. Group 2 included only one who was diagnosed with SHPT, a normal value of iPTH with concomitant normocalcemia was achieved after 4 days of hydrochlorothiazide therapy (baseline Caadj. 2.35 mmol/l, iPTH 74.5 pg/ml vs at 2.27 mmol/l and 50.7 pg/ml respectively). Patients with doubtful results of the test entered in group 3 (n=6), they did not achieve significant changes in the calcium and iPTH levels, so it was recommended to continue the test on an outpatient basis (baseline Caadj. 2.39 mmol/l [2.33;2.45], iPTH 97.0 pg/ml [83.1;117.0]); after short test - 2.47 mmol/l [2.42; 2.48] and 91.3 pg/ml [86.9; 124.0] respectively). Groups with PHPT and SHPT and doubtful results significantly differed from each other in Caadj (р=0.003, U-test, Bonferroni correction Р0=0.006), but not in iPTH, daily calciuria, eGFR, and phosphorus. There were no significant differences in the incidence of classical complications of PHPT.

Conclusion: The diagnosis of PHPT was confirmed in 21/28 patients 3-5 days after taking hydrochlorothiazide 50 mg/day. The obtained results are significant for the differential diagnosis in hospitalized patients with an unspecified genesis of hyperparathyroidism.

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[短期试验氢氯噻嗪在原发性正常血钙血症和继发性甲状旁腺功能亢进住院治疗中的鉴别诊断]。
背景:高钙尿引起的常钙原发性甲状旁腺功能亢进症(nPHPT)和继发性甲状旁腺功能减退症(SHPT)的鉴别诊断仍然是一个挑战。目的:本研究的目的是探讨氢氯噻嗪短时间试验对nPHPT和SHPT的鉴别诊断能力。材料和方法:对28名患者进行了回顾性研究,这些患者在住院期间接受了噻嗪类利尿剂的功能试验内分泌研究中心,俄罗斯。结果:根据基线和动态生化评估,将患者分为3组。第1组(n=21)包括确诊为PHPT的患者,他们达到高钙血症并伴有iPTH水平升高(n=19)或iPTH水平增加并伴有正常血钙(n=2)。在第1组中,基线Caadj。为2.48 mmol/l[2.47;2.52],iPTH为107.5 pg/ml[86.8;133.0],短期试验后为-2.63 mmol/l[2.59;2.66]和102.1 pg/ml[95,7;124,1]。第2组仅包括一名被诊断为SHPT的患者,在氢氯噻嗪治疗4天后,iPTH的正常值并伴有正常血钙(基线Caadj.2.35 mmol/l,iPTH 74.5 pg/ml vs 2.27 mmol/l和50.7 pg/ml)。试验结果可疑的患者进入第3组(n=6),他们的钙和iPTH水平没有发生显著变化,因此建议在门诊基础上继续进行试验(基线Caadj.2.39 mmol/l[2.33;2.45],iPTH 97.0 pg/ml[83.1;117.0]);短期试验后分别为2.47 mmol/l[2.42;2.48]和91.3 pg/ml[86.9;124.0])。PHPT和SHPT组和可疑结果组在Caadj方面存在显著差异(р=0.003,U型检验,Bonferroni校正Р0=0.006),但在iPTH、每日钙尿、eGFR和磷方面没有差异。PHPT典型并发症的发生率无显著差异。结论:21/28例患者在服用氢氯噻嗪50mg/天后3-5天确诊为PHPT。所获得的结果对于不明原因的甲状旁腺功能亢进住院患者的鉴别诊断具有重要意义。
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来源期刊
Problemy endokrinologii
Problemy endokrinologii Medicine-Endocrinology, Diabetes and Metabolism
CiteScore
1.40
自引率
0.00%
发文量
59
期刊介绍: Since 1955 the “Problems of Endocrinology” (or “Problemy Endocrinologii”) Journal publishes timely articles, balancing both clinical and experimental research, case reports, reviews and lectures on pressing problems of endocrinology. The Journal is aimed to the most topical issues of endocrinology: to chemical structure, biosynthesis and metabolism of hormones, the mechanism of their action at cellular and molecular level; pathogenesis and to clinic of the endocrine diseases, new methods of their diagnostics and treatment. The Journal: features original national and foreign research articles, reflecting world endocrinology development; issues thematic editions on specific areas; publishes chronicle of major international congress sessions and workshops on endocrinology, as well as state-of-the-art guidelines; is intended for scientists, endocrinologists diabetologists and specialists of allied trade, general practitioners, family physicians and pediatrics.
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