CLINICAL MANIFESTATIONS OF PRIMARY HYPERPARATHYROIDISM VARIANTS IN PATIENTS EXAMINED IN AN ENDOCRINOLOGICAL CLINIC
Keywords:Key words: primary hyperparathyroidism, clinical variants, diagnostics, monitoring.
Purpose of the study. To establish the structure of clinical variants of PGPT in patients examined in an endocrinological clinic.
Materials and methods. Examined 36 patients with PGPT, treated in the surgical department of the clinic of the State Institution "IPEP" for the period 2018-2020. Analyzed complaints, the state of the bone, cardiovascular, digestive systems and kidneys. The levels of PTH in blood serum, total and ionized blood calcium, blood phosphorus, calciumuria and phosphoruria levels were investigated. An ultrasound of the neck organs was performed. Results. The surveyed group was dominated by women. In all patients ultrasound revealed adenomas of the thyroid gland. Moreover, 70% had a mild form of the disease. Organ pathology was established in 30% of the examined patients, incl. on the part of the kidneys (22.2%), the cardiovascular system (19.4%), the digestive tract (13.8%), the skeletal system (13.8%). In most patients, a significant increase in total and ionized blood calcium was found, which was always accompanied by an increase in the level of PTH. In the postoperative period, on the first day, the levels of PTH significantly decreased (Р˂0,05), and on the 3-4th day there was a decrease in the level of valence and ionized Ca (P˂0,05).
Conclusions. 1.In order to optimize the work on identifying patients with PGPT, it is recommended that family physicians refer patients with complaints of general weakness, loss of appetite, myalgia, and bone pain to an endocrinologist. Particular attention should be paid to persons with pathological fractures, recurrent urolithiasis, cysts of the upper jaw. Detection of elevated calcium in the blood, even a slight one, will link these complaints with the presence of HPT. 2. It is advisable to use questionnaires for outpatient visits, which allow you to quickly and thoroughly examine the pathological condition of patients. 3. Today, surgical treatment is the most effective method of treating PGPT. It should be carried out even with asymptomatic forms of the disease, which helps to prevent the development of severe, incurable complications.
Zhu CY, Sturgeon C, Yeh MW. JAMA 2020;323(12):1186-1187. https://doi.org/10.1001/jama.2020.0538.
Cheren'ko SM. Pervichnyj giperparatireoz: osnovy patogeneza, diagnostiki i hirurgicheskogo lechenija, Kiev, 2011: 147 p.
Vignali E, Cetani F, Chiavistelli S, et al. Endocr Connect 2015;4(3): 172-178.
Bilezikian JP. J Clin Endocrinol Metab 2018;103(11): 3993-4004. https://doi.org/10.1210/jc.2018-01225.
Makarov IV. Giperparatireoz: uchebnoe posobie, Samara, 2014: 132 p.
Farhutdinova LM. Arhiv Vnutrennej Mediciny 2020; 10(2): 94-101. https://doi.org/10.20514/2226-6704-2020-10-2-94-101.
Farhutdinova LM, Mohammad SJu, Jamaev IM, Abdulguzhin BI. Jendokrinnaja Hirurgija 2020;14(2): 21-24. https://doi.org/10.14341/serg12302.
Dedov II, Mel'nichenko GA, Mokrysheva NG, et al. Problemy Jendokrinologii 2016;62(6): 40-77. https://doi.org/10.14341/probl201662640-77.
Janevskaja LG, Karonova TL, Slepcov IV, et al. Klin Jeksper Tireoidologija 2019;15(1): 19-29. https://doi.org/10.14341/ket10213.