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Hiperparatiroidismo primario: Evolución postoperatoria a largo plazo / Primary hyperparathyrodism: Postoperative long-term evolution
Spivacow, Francisco R.; Martínez, Carolina; Polonsky, Ana.
Affiliation
  • Spivacow, Francisco R.; Instituto de Investigaciones Metabólicas.
  • Martínez, Carolina; Instituto de Investigaciones Metabólicas.
  • Polonsky, Ana; Instituto de Investigaciones Metabólicas.
Medicina (B.Aires) ; Medicina (B.Aires);70(5): 408-414, oct. 2010. tab
Article in Es | LILACS | ID: lil-633777
Responsible library: AR1.2
RESUMEN
Presentamos la evolución postoperatoria a largo plazo de 87 pacientes con hiperparatiroidismo primario. Del total, 78 mujeres y 9 varones, relación 8.71. Edad media 55.3 ± 10.2 años. Antes de la cirugía el 44% presentó litiasis renal, el 70% osteopenia u osteoporosis y un 71.2% tuvo hipercalciuria. Se encontró disminución del filtrado glomerular en el 12.6%. Del total, 72 pacientes presentaron un adenoma único, dos un doble adenoma, dos hiperplasia, cuatro histología normal y en siete no se pudo disponer del resultado. El calcio sérico, el calcio iónico, el fósforo y la parathormona intacta se normalizaron en todos los pacientes postcirugía. La densitometría ósea aumentó un 6.9% en columna lumbar y un 3% en cuello de fémur. Los marcadores del remodelado óseo se normalizaron y persistieron normales a los 23 meses del seguimiento, coincidiendo con la parathormona intacta. Lo mismo sucedió con los valores de 25 OH D. Cuando se compararon pacientes con hipercalciuria inicial vs. aquellos con normocalciuria, no se encontraron diferencias en los valores basales y postcirugía en ambos grupos. En 11 pacientes con filtrado glomerular previo < 60 ml/min, encontramos una parathormona intacta más elevada que el resto y menor densidad mineral ósea. El filtrado glomerular no cambió en forma significativa luego de la cirugía. En conclusión, el hiperparatiroidismo primario operado por cirujanos especializados tiene una excelente evolución a largo plazo, con normalización de todos los parámetros del metabolismo fosfocálcico y del remodelado óseo y mejoría significativa en la densidad mineral ósea. Los efectos adversos son escasos y de resolución espontánea.
ABSTRACT
The long-term postoperative outcome of 87 patients with primary hyperparathyrodism is here presented. Of the total 78 were females and 9 males, ratio 8.71. Mean age 55.3 ± 10.2 years. Before surgery, 44% had kidney stones, 70% had osteopenia or osteoporosis and 71.2% had hypercalciuria. Decrease renal glomerular filtration was found in 12.6%. Of the total, 72 patients had a single adenoma, two double adenoma, two hyperplasia, four had normal histology and seven could not dispose of the result. Serum calcium, ionized calcium, phosphorus and intact parathyroid hormone were normalized in all post surgery patients. Bone mineral density increased by 6.9% in lumbar spine and 3% in femoral neck. Markers of bone remodeling were normalized and persisted normal 23 months of follow-up, coinciding with the normal intact parathyroid hormone. Same thing happened with the values of 25 OH D. When patients whith initial hypercalciuria were compared with those with normocalciuria, no differences were found in the basal values and postsurgery in both groups. In 11 patients with previous renal glomerular filtration < 60 ml / min, we found a higher intact parathyroid hormone and lower bone mineral density than the rest. The glomerular filtration rate did not change significantly after surgery. In conclusion, the surgical primary hyperparathyroidism, operated by specialized surgeons has an excellent long-term outcome, with normalization of all parameters of phosphocalcic metabolism and bone remodeling and significant improvement in bone mineral density. Adverse effects were scarce and had spontaneous resolution.
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Full text: 1 Index: LILACS Main subject: Parathyroid Hormone / Hyperparathyroidism, Primary Type of study: Observational_studies / Prognostic_studies Limits: Aged / Female / Humans / Male Language: Es Journal: Medicina (B.Aires) Journal subject: MEDICINA Year: 2010 Type: Article
Full text: 1 Index: LILACS Main subject: Parathyroid Hormone / Hyperparathyroidism, Primary Type of study: Observational_studies / Prognostic_studies Limits: Aged / Female / Humans / Male Language: Es Journal: Medicina (B.Aires) Journal subject: MEDICINA Year: 2010 Type: Article