复发性或持续性原发性甲状旁腺功能亢进症，甲状旁腺瘤病

文献信息

中文摘要

持续性原发性甲状旁腺功能亢进症定义为甲状旁腺手术后6个月内高钙血症持续存在或复发。复发性原发性甲状旁腺功能亢进症定义为在最初治愈性甲状旁腺切除术后超过6个月原发性甲状旁腺功能亢进症复发。在这些情况下，必须排除鉴别诊断，特别是继发性甲状旁腺功能亢进症和家族性低尿钙性高钙血症。在非专家中心，原发性甲状旁腺功能亢进症初次手术时未能切除病变甲状旁腺是最常见的情况。在其他情况下，必须筛查遗传决定的多腺体原发性甲状旁腺功能亢进症。更罕见的是，发现第二个散发性腺瘤，或者极少数情况下，甲状旁腺癌或甲状旁腺瘤病。在任何新的甲状旁腺手术之前，有效的形态学评估，结合形态学和功能成像，是必不可少的。手术指征必须在多学科团队中讨论，评估风险/获益比，因为手术并发症的风险更高。翻修手术应在喉镜检查后，在专家中心采用合适的方法进行，最好进行术中PTH测量和喉返神经神经监测。

英文摘要

Persistent primary hyperparathyroidism is defined as the persistence or recurrence of hypercalcemia within 6 months of parathyroid surgery. Recurrent primary hyperparathyroidism is defined as the recurrence of primary hyperparathyroidism more than 6 months after an initially curative parathyroidectomy. In these situations, it is essential to rule out differential diagnoses, and in particular secondary hyperparathyroidism and familial hypocalciuric hypercalcemia. Failure to remove the pathological parathyroid gland or glands during initial surgery for primary hyperparathyroidism is the most common situation in non-expert centers. In other situations, genetically determined multi-glandular primary hyperparathyroidism must be screened for. More rarely, a second sporadic adenoma is identified, or, exceptionally, a parathyroid carcinoma or parathyromatosis. Effective morphological evaluation, combining a morphological and functional imaging, is essential prior to any new parathyroid surgery. The indications for surgery must be discussed in a multidisciplinary team, assessing the risk/benefit ratio, since the risk of surgical complications is higher. Revision surgery should be performed using a suitable approach, after laryngoscopy, in an expert center, ideally with intraoperative PTH measurement and recurrent nerve neuromonitoring.