正常钙血症甲状旁腺功能亢进症的自然病史和并发症:一项回顾性队列研究。

IF 3.4 Q2 ENDOCRINOLOGY & METABOLISM JBMR Plus Pub Date : 2024-05-31 eCollection Date: 2024-07-01 DOI:10.1093/jbmrpl/ziae074
Caroline Wei Shan Hoong, Stephen M Broski, Jad G Sfeir, Bart Lyman Clarke
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引用次数: 0

摘要

正常钙血症甲状旁腺功能亢进症(NHPT)的定义各不相同,有关并发症和自然病史的信息也很少。我们的目的是描述NHPT与高钙血症性甲状旁腺功能亢进症(PHPT)和对照组的表型,确定进展的风险,并建立进展为PHPT的预测模型。这是一项对一家三级医疗中心232名患者进行的回顾性病历审查,比较了75名对照组患者、73名NHPT患者和84名PHPT患者。就 cCa、iPTH、cCa 的个体内变异系数、磷和 25(OH)D 而言,NHPT 在生化特征方面介于对照组和 PHPT 之间。在对年龄、性别和体重指数进行调整后,NHPT 患者与对照组相比,患尿路结石的调整后风险增加(OR 5.34,95%CI,2.41-12.71,P P = .006)。通过甲状旁腺切除术治愈的 NHPT 患者少于 PHPTH 患者(P = .001)。NHPT更常见于非定位成像或多腺体疾病(P = .005)。甲状旁腺切除术改善了 NHPT 患者的生化指标,但未改善 BMD 指标。在中位随访 4.23(IQR 1.76-5.31)年期间,NHPT 患者的 iPTH 无变化,9% 的患者进展为 PHPT。一个 XGBoost 模型结合了 6 个进展因素(平均指数 2 iPTH、平均指数 2 cCa、24 小时尿钙、年龄、25(OH)D 和是否存在尿路结石),其曲线下面积为 1.00(95%CI,1.00-1.00,P<0.05)。
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Natural history and complications of normocalcemic hyperparathyroidism: a retrospective cohort study.

Normocalcemic hyperparathyroidism (NHPT) is variably defined, and information regarding complications and natural history are scarce. We aimed to describe the phenotype of NHPT in relation to hypercalcemic hyperparathyroidism (PHPT) and controls, to determine risk of progression, and to develop a predictive model for progression to PHPT. This is a retrospective chart review of 232 patients at a tertiary medical center, comparing 75 controls, 73 patients with NHPT, and 84 with PHPT. NHPT was intermediate in biochemical profile between controls and PHPT with respect to cCa, iPTH, intraindividual coefficient of variant of cCa, phosphorus, and 25(OH)D. NHPT patients had an increased adjusted risk of urolithiasis (OR 5.34, 95%CI, 2.41-12.71, P < .001) and fragility fractures (OR 4.53, 95%CI, 1.63-14.84, P = .006) versus controls, after adjustment for age, sex, and BMI. Fewer NHPT compared with PHPTH patients achieved cure with parathyroidectomy (P = .001). NHPT more often had nonlocalizing imaging or polyglandular disease (P = .005). Parathyroidectomy improved biochemical but not BMD parameters in NHPT. Over a median follow-up of 4.23 (IQR 1.76-5.31) years, NHPT patients managed expectantly experienced no change in iPTH, and progression to PHPT occurred in 9%. An XGBoost model combining 6 factors for progression (mean index 2 iPTH, mean index 2 cCa, 24-h urinary calcium, age, 25(OH)D, and presence of urolithiasis) had an area under the curve 1.00 (95%CI, 1.00-1.00, P < .001) for predicting combined progression. NHPT is a mild variant of PHPT at intermediate risk of urolithiasis and fragility fractures. Cure was less often achieved with parathyroidectomy, which did not improve BMD parameters. Progression was infrequent with conservative management. Because only a minority progressed to PHPT, in addition to lower surgical success rates, we suggest conservative management for the majority of NHPT unless risk factors for progression are identified.

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来源期刊
JBMR Plus
JBMR Plus Medicine-Orthopedics and Sports Medicine
CiteScore
5.80
自引率
2.60%
发文量
103
审稿时长
8 weeks
期刊最新文献
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