Therapeutic and diagnostic algorithm for the management of patients with primary hyperparathyroidism
Abstract
Background. Primary hyperparathyroidism (PHPT), being one of the leading endocrine pathologies, requires a special approach both in diagnosis and treatment.
Aim. Optimization of the therapeutic and diagnostic algorithm in primary hyperparathyroidism by introducing integral indicators in laboratory and 3D modeling in instrumental diagnostics of this pathology.
Materials and methods. The study included 102 patients diagnosed with PHPT. There were 15 men (14.7%), women — 87 (85.3%). The mean age was 58.96±1.61 years. The first group, 74 people (72.5%), consisted of patients with symptomatic hyperparathyroidism (sPHPT) hypercalcemic form. The second group, 28 patients (27.5%), consisted of patients with doubtful laboratory and/or clinical manifestations of PHPT: with asymptomatic hyperparathyroidism (bPHPT), hypercalcemic (10 patients) and normocalcemic (2 patients), and patients with symptomatic hyperparathyroidism, normocalcemic form (16 patients). The control group consisted of 38 healthy volunteers. For the diagnosis of PHPT, the proposed integral indicators of hyperparathyroidism (IPHPT index and CPHGPT coefficient of primary hyperparathyroidism) were used. For the topical diagnosis of parathyroid adenomas (PTG), 3D modeling of the neck organs based on CT/MRI studies was introduced.
Results. As a result of the examination of 38 healthy volunteers, it was revealed that the IPHPT values were >2,46, and the CPHPT values >1,95. In all patients with PHPT before surgery, the IPHPT was ≤2,46 and the CPHPT ≤1,95. After surgery, the mean values of IPHPT and CPHPT approached the mean values of healthy volunteers which confirmed the effectiveness of the operation. Preoperative 3D modeling made it possible to accurately determine the location of PTG lesions, to abandon revision operations in favor of selective parathyroidectomy, and to reduce the time of operations by 1,8 times (p=0,041).
Conclusion. Optimization of the therapeutic and diagnostic algorithm by introducing integral indicators in laboratory and 3D modeling in instrumental diagnostics of primary hyperparathyroidism greatly facilitates the management of patients in this category and the choice of the scope of surgical intervention.
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