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Inicio Endocrinología y Nutrición Evolución del hiperparatiroidismo primario en 56 pacientes. Comparación entre ...
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Vol. 54. Núm. 7.
Páginas 347-353 (Agosto 2007)
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Vol. 54. Núm. 7.
Páginas 347-353 (Agosto 2007)
Originales
DOI: 10.1016/S1575-0922(07)71464-X
Acceso a texto completo
Evolución del hiperparatiroidismo primario en 56 pacientes. Comparación entre hiperparatiroidismo hipercalcémico y normocalcémico
Progression of primary hyperparathyroidism in 56 patients. Comparison between hypercalcemic and normocalcemic hyperparathyroidism
Visitas
...
Cristina Familiara,
Autor para correspondencia
crisfami@terra.es

Correspondencia: Dra. C. Familiar. Servicio de Endocrinología. Hospital Virgen de la Salud. Av. de Barber, s/n. 45004 Toledo. España.
, Bárbara Cánovasa, Manuel Ángel Gargallob, Julia Sastrea, Amparo Marcoa, Almudena Vicentea, José Lópeza, Enrique Castroa
a Servicio de Endocrinología. Hospital Virgen de la Salud. Toledo. España
b Servicio de Endocrinología. Hospital Virgen de la Torre. Madrid. España
Información del artículo
Introducción

Actualmente, el hiperparatiroidismo primario (HPP) se considera una enfermedad escasamente sintomática y poco progresiva. El HPP normocalcémico (HPPN) es una entidad reconocida e identificada esencialmente por complicaciones asociadas al HPP (osteoporosis y urolitiasis).

Pacientes y método

Estudio de 56 pacientes con HPP no operados o con seguimiento mínimo de 1 año previo a la paratiroidectomía. Se subdividió a los pacientes en HPP hipercalcémico (HPPH) (27 pacientes) y HPPN (29 pacientes). Se pretendió analizar las comorbilidades hipertensión arterial [HTA] y nefrolitiasis) en el grupo total y en cada subgrupo, valorar la evolución anual de calcemia, fosfatemia, paratirina PTH) y fosfatasa alcalina séricas, calciuria, filtrado glomerular y densidad mineral ósea lumbar durante un período de 1 a 5 años y hallar posibles diferencias entre HPPH y HPPN para estas variables.

Resultados

El 55,4% de los pacientes presentaban HTA y se registraron episodios de nefrolitiasis en el 37,5% de los casos. No se apreciaron cambios a lo largo del tiempo en los parámetros bioquímicos y densitométricos ni en el grupo total ni por subgrupos. Excepto en los valores de calcio, fósforo y PTH séricos no se hallaron diferencias entre HPPH y HPPN.

Conclusiones

El HPP parece una enfermedad poco progresiva si bien no se incluyó en este estudio a los pacientes remitidos precozmente a cirugía con seguimiento previo escaso que podrían corresponder a casos más agresivos. El HPPN es una entidad asociada a complicaciones similares a las del HPPH por lo que pensamos debería someterse a los mismos criterios de derivación quirúrgica.

Palabras clave:
Hiperparatiroidismo primario
Hiperparatiroidismo normocalcémico
PTH
Paratirina
Calciuria
Calcemia
Fosfatemia
Osteoporosis
Nefrolitiasis
Introduction

Primary hyperparathyroidism (PHP) is considered a relatively stable, asymptomatic disease. Normocalcemic PHP (NPHP) is now a recognized entity that is usually diagnosed through its associated complications (such as osteoporosis and nephrolithiasis).

Patients and method

We studied 56 patients with PHP who did not undergo surgery or who completed a minimum follow-up of 1 year before parathyroid surgery. The group was subdivided into patients with hypercalcemic PHP (HPHP) (27 patients) and those with NPHP (29 patients). The presence of comorbidities (hypertension, nephrolithiasis) was analyzed in the whole group and in each subset of patients, as was yearly progression of calcemia, phosphatemia, serum parathyroid hormone (PTH) and alkaline phosphatase, urinary calcium, glomerular filtration rate and bone mineral density in the lumbar spine during a follow-up period ranging from 1 to 5 years. Possible differences in these variables between HPHP and NPHP were also studied.

Results

A total of 55.4% of the patients were hypertensive and nephrolithiasis events were reported in 37.5%. No changes were observed in biochemical or densitometric variables over time or in the whole group or in the subgroups. Except for serum calcium, phosphate and PTH values, no differences were found between HPHP and NPHP.

Conclusions

PHP seems to be a relatively stable disease, although patients referred early to surgery with a short follow-up, who could have had more aggressive kinds of PHP, were not included in this study. The complications of NPHP are similar to those of HPHP and therefore we believe the same recommendations for surgery should be followed in both forms.

Key words:
Primary hyperparathyroidism
Normocalcemic hyperparathyroidism
PTH
Parathyroid hormone
Calciuria
Calcemia
Phosphatemia
Osteoporosis
Nephrolithiasis
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