Читать книгу Parathyroid Disorders - Группа авторов - Страница 28

Asymptomatic primary hyperparathyroidism has become the most common presentation of primary hyperparathyroidism in Europe and North America, and an increasingly common presentation in other parts of the world. As many as 25% of asymptomatic patients may develop indications for parathyroidectomy when followed long-term for up to 15 years. Patients who remain asymptomatic should be monitored for the development of complications that justify surgery. Patients who become symptomatic should be referred for surgery. Surgery may improve quality of life even in patients who remain asymptomatic.

© 2019 S. Karger AG, Basel

Asymptomatic primary hyperparathyroidism (PHPT) is viewed as a milder presentation of classical PHPT [1]. Despite meeting biochemical criteria for the diagnosis, asymptomatic patients often do not meet other criteria for surgery, and many patients without symptoms are observed without surgery. Over time, some of these patients progress to symptomatic PHPT and require surgery, whereas others remain asymptomatic. Asymptomatic patients who meet other criteria for surgery at the initial evaluation, such as having osteoporosis or low-trauma fractures, calcium-containing kidney stones, hypercalciuria, or serum calcium more than 1.0 mg/dL above the normal range, are usually advised to have surgery [2]. Most patients in Europe and North America present with asymptomatic PHPT in the modern era, whereas patients elsewhere in the world more commonly have symptomatic PHPT [3].