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首页> 外文期刊>International Journal of Endocrinology and Metabolism >ADVANCED BONE DISEASE AS THE MOST COMMON CLINICAL PRESENTATION OF PRIMARY HYPERPARATHYROIDISM IN IRANIANS: CLINICAL AND LABORATORY FEATURES OF 62 PATIENTS FROM NORTH-WESTERN IRAN
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ADVANCED BONE DISEASE AS THE MOST COMMON CLINICAL PRESENTATION OF PRIMARY HYPERPARATHYROIDISM IN IRANIANS: CLINICAL AND LABORATORY FEATURES OF 62 PATIENTS FROM NORTH-WESTERN IRAN

机译：晚期骨疾病是Iranias原发性高副甲状腺功能亢进症的最常见临床表现：来自西北伊朗的62例患者的临床和实验室特征

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The original studies of Albright and Reifenstein characterized primary hyperparathyroidism as a disease of “bones and stones”. The disease at present is recognized most frequently as a totally asymptomatic condition, detection being based on the finding of hypercalcemia in the routine screening of serum calcium levels. The purpose of this cross sectional clinical case study was to analyze the clinical, biochemical, radiological, and pathological features of the disease in Iranians and to compare these features with those of patients from western countries. Materials and Methods: From 1985 through 2002, sixty-two patients with primary hyperparathyroidism were studied from the north-western part of Iran . In addition to routine studies, the following evaluations were conducted; 1) measurements of serum calcium, phosphorous, alkaline phosphatase, creatinine and electrolytes; 2) X-rays of skull, hands, clavicles, pelvis, vertebral bones, abdomen, long bones, and dental film of lamina dura, and 3) Intravenous pyelogram and/or ultrasonography of kidneys. PTH was measured in only 29 patients because of lack of reliable laboratory methods during the earlier years of the study. Surgery was performed in all subjects and they were followed postoperatively. Results: There were 52 females and 10 males, with a female to male ratio of 5.2:1, and an age range of 13 to 71 years with a mean age of 38/6 years. The peak incidence in both sexes was in the 4th decade. The vast majority of patients in this series presented with symptoms referable to skeletal involvement. Fifty-eight (93.5%) patients suffered from bone pains, deformities, pathologic fractures, and localized bone tumors. Renal colic was a less frequent complaint; only in 4 patients (6.4%) clinical renal disease led to the diagnosis of hyperparathyroidism. No patient was asymptomatic. Fifty-four patients had persistent?hypercalcemia. In 3 patients hypercalcemia was intermittent and 5 patients were normocalcemic. Mean serum calcium concentration was 11.2 mg/dl (range 9.3-15.6 mg/dl). A high proportion of the patients, 49 of 62, had low serum phosphorus level. Mean serum phosphate concentration was 2.1 mg/dl (range 1.4-3.6 mg/dl). Interestingly, all 5 normocalcemic patients were hypophosphatemic. Serum alkaline phosphatase level was elevated in 56 patients, and PTH concentration was high in all the 29 patients in whom it was measured. All patients displayed some radiologic changes. Subperiosteal resorption of phalanges and/or distal clavicles was the most frequent (43/62) radiologic finding. Salt and pepper appearance on skull x- rays, brown tumor in pelvis, metacarpals, and long bones were other common radiologic features. Pathologic fractures were found in 32 patients, including vertebral collapse in 3 patients. The pathologic findings were single adenoma in 54 patients, double adenoma in 3 subjects, hyperplasia in 4 patients (2 patients with MEN –1 and one with MEN-2), and parathyroid carcinoma in 1 patient.Conclusion: This study shows that advanced bone disease is the most frequent clinical presentation of hyperparathyroidism in Iranians. Routine serum calcium measurement is recommended at least in high-risk patients, in particular for females in their 4th – 5th decades of life.
机译：Albright和Reifenstein的原始研究将原发性甲状旁腺功能亢进症称为“骨骼和结石”疾病。目前，该病最常被认为是完全无症状的疾病，其检测是基于常规筛查血清钙水平时发现的高钙血症。这项横断面临床案例研究的目的是分析伊朗人疾病的临床，生化，放射学和病理学特征，并将这些特征与西方国家的患者进行比较。材料与方法：从1985年至2002年，从伊朗西北部研究了62例原发性甲状旁腺功能亢进症患者。除常规研究外，还进行了以下评估： 1）测量血清钙，磷，碱性磷酸酶，肌酐和电解质; 2）颅骨，手，锁骨，骨盆，椎骨，腹部，长骨和椎板硬膜的X线片，以及3）静脉肾盂造影和/或肾脏超声检查。由于研究的前几年缺乏可靠的实验室方法，因此仅对29名患者进行了PTH测量。在所有受试者中均进行了手术，并在术后进行了随访。结果：女性52例，男性10例，男女之比为5.2：1，年龄范围为13至71岁，平均年龄为38/6岁。男女的发病率最高是在第四个十年。该系列的绝大多数患者表现出与骨骼受累有关的症状。 58名（93.5％）患者患有骨痛，畸形，病理性骨折和局部骨肿瘤。肾绞痛的投诉较少。仅4例（6.4％）临床肾病导致了甲状旁腺功能亢进症的诊断。没有患者是无症状的。 54名患者持续存在高钙血症。在3例患者中，高钙血症是间歇性的，5例患者为正常血钙性的。平均血清钙浓度为11.2 mg / dl（范围9.3-15.6 mg / dl）。 62％的患者中有49％的患者血清磷水平较低。平均血清磷酸盐浓度为2.1 mg / dl（范围为1.4-3.6 mg / dl）。有趣的是，所有5名正常血钙患者均为低磷酸盐血症。 56例患者的血清碱性磷酸酶水平升高，所有29例患者的PTH浓度均较高。所有患者均表现出一些放射学改变。指骨和/或远端锁骨的骨膜下吸收是最常见的放射学发现（43/62）。其他常见的放射学特征包括颅骨X射线上的盐和胡椒外观，骨盆的褐色瘤，掌骨和长骨。病理骨折32例，其中椎体塌陷3例。病理结果为单发腺瘤54例，双发腺瘤3例，增生4例（MEN –1例2例，MEN-2例2例），甲状旁腺癌1例。该疾病是伊朗人甲状旁腺功能亢进症最常见的临床表现。建议至少在高危患者中进行常规血清钙测量，特别是对于4至5岁女性。

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