Normohormonal primary hyperparathyroidism: A systematic review and meta-analysis - 29/08/23
, Jacob J. Wiseman , Sam M. Wiseman ⁎ Abstract |
Objective |
We aim to evaluate the body of evidence reporting on normohormonal primary hyperparathyroidism (NHpHPT) patients to help guide their diagnosis, characterization and treatment.
Background |
Normohormonal primary hyperparathyroidism is a term used to describe patients with a normal PTH and elevated calcium levels. There is limited understanding regarding the presentation and appropriate management of these patients.
Methods |
A systematic review was conducted: abstract and full-text screening were independently conducted by 2 investigators. Odds ratios (OR), standard mean differences (SMD) and 95% confidence intervals were calculated.
Results |
Twenty-two studies were identified. Patients with NHpHPT were more likely to present with lower PTH (p < 0.00001) and calcium (p < 0.00001) levels. Intraoperatively, the NHpHPT group was 1.8 times more likely to undergo bilateral neck exploration (BNE) and harbor multigland disease. The rates of surgical cure were 93% in the NHpHPT and 96% in the pHPT groups (p = 0.0003).
Conclusion |
Symptomatic patients with NHpHPT benefit from parathyroidectomy with prolonged intraoperative PTH monitoring, and a low threshold for conversion to BNE.
Le texte complet de cet article est disponible en PDF.Highlights |
• | Patients with NHpHPT present with lower levels of PTH, calcium and higher levels of phosphate, vitamin D, and urine calcium. |
• | NHpHPT patients were significantly more likely to present with nephrolithiasis and osteopenia. |
• | Intraoperatively, NHpHPT cases were twice as likely to harbor multigland disease and undergo a bilateral neck excision. |
• | Rates of cure of patients with NHpHPT after parathyroidectomy were than in classic primary hyperparathyroidism. |
Keywords : Primary hyperparathyroidism, Normohormonal, Parathyroid hormone, Calcium
Plan
Vol 226 - N° 2
P. 186-196 - août 2023 Retour au numéro
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