A thorough evaluation for primary hyperparathyroidism: More than a stone's throw away

IF 2.7 3区医学 Q1 SURGERY

American journal of surgery Pub Date : 2024-09-17 DOI:10.1016/j.amjsurg.2024.115978

Rebecca L. Green , Rajiv Raghavan , Laura M. Douglass , Jennifer Sykes , Patricia Dunham , Terry P. Gao , Lindsay Talemal , George A. Taylor , Lindsay E. Kuo

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引用次数: 0

Abstract

Background

Primary hyperparathyroidism (PHPT) is a treatable cause of nephrolithiasis. However, PHPT is not consistently evaluated in nephrolithiasis patients. Symptoms of parathyroid disease were explored in relation to evaluation of PHPT in nephrolithiasis patients.

Methods

Patients with nephrolithiasis on imaging between 2017 and 2021 were identified. Measurement of serum calcium levels after nephrolithiasis diagnosis was determined. Patients with hypercalcemia (

\geq

10.2 mg/dL) were identified. Characteristics associated with parathyroid hormone (PTH) evaluation and specialist referral were assessed.

Results

Of 2264 nephrolithiasis patients with calcium levels measured, 383 (17.1 %) had hypercalcemia. Of those, 107 (27.9 %) had PTH levels drawn. PTH was more often assessed in patients with higher median calcium levels, recurrent nephrolithiasis, depression, and osteopenia/osteoporosis. PTH was elevated (>64 pg/mL) or non-suppressed (40–64 pg/mL) in 68 (63.6 %) patients. Of those, 31 (45.6 %) were referred to a parathyroid specialist. Referred patients had higher PTH and calcium levels than those without referral, and higher rates of osteopenia/osteoporosis.

Conclusions

PTH evaluation in hypercalcemic nephrolithiasis patients was low. The majority of patients evaluated had elevated or non-suppressed PTH levels, but only a fraction were referred to a specialist.

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全面评估原发性甲状旁腺功能亢进症一石激起千层浪

背景原发性甲状旁腺功能亢进症（PHPT）是肾结石的一种可治疗原因。然而，对肾结石患者的PHPT评估并不一致。研究人员探讨了甲状旁腺疾病的症状与肾炎患者 PHPT 评估的关系。方法确定了 2017 年至 2021 年期间通过影像学检查患有肾炎的患者。测定肾结石诊断后的血清钙水平。确定了高钙血症（≥ 10.2 mg/dL）患者。结果在测量血钙水平的 2264 名肾结石患者中，383 人（17.1%）患有高钙血症。其中 107 人（27.9%）检测了 PTH 水平。中位钙水平较高、复发性肾结石、抑郁症和骨质疏松/骨质疏松症患者更常接受 PTH 评估。68例（63.6%）患者的PTH升高（64 pg/mL）或未受抑制（40-64 pg/mL）。其中31人（45.6%）被转诊至甲状旁腺专科医生。与未转诊的患者相比，转诊患者的PTH和血钙水平更高，骨质疏松症/骨质疏松症的发生率也更高。大多数接受评估的患者PTH水平升高或未受抑制，但只有一小部分患者被转诊至专科医生。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

American journal of surgery 医学-外科

CiteScore

5.00

自引率

6.70%

发文量

570

审稿时长

56 days

期刊介绍： The American Journal of Surgery® is a peer-reviewed journal designed for the general surgeon who performs abdominal, cancer, vascular, head and neck, breast, colorectal, and other forms of surgery. AJS is the official journal of 7 major surgical societies* and publishes their official papers as well as independently submitted clinical studies, editorials, reviews, brief reports, correspondence and book reviews.