Sporadic primary hyperparathyroidism and stone disease: a comprehensive metabolic evaluation before and after parathyroidectomy

被引:11
作者
Marchini, Giovanni S. [1 ,2 ]
Faria, Kauy V. M. [1 ]
Torricelli, Fabio C. M. [1 ,2 ]
Monga, Manoj
Srougi, Miguel [1 ]
Nahas, William C. [1 ]
Mazzucchi, Eduardo [1 ]
机构
[1] Univ Sao Paulo, Sch Med, Hosp Clin, Sect Endourol,Div Urol, Av Dr Eneas Carvalho de Aguiar 255, BR-05403900 Sao Paulo, Brazil
[2] Cleveland Clin, Glickman Urol & Kidney Inst, Cleveland, OH 44106 USA
关键词
kidney calculi; metabolic evaluation; primary hyperparathyroidism; 3RD INTERNATIONAL WORKSHOP; KIDNEY-STONES; MEDICAL-MANAGEMENT; UROLITHIASIS; PATHOPHYSIOLOGY; ABNORMALITIES; PREVALENCE; FEATURES; RISK;
D O I
10.1111/bju.14072
中图分类号
R5 [内科学]; R69 [泌尿科学(泌尿生殖系疾病)];
学科分类号
1002 ; 100201 ;
摘要
Objectives To characterize the stone risk and the impact of parathyroidectomy on the metabolic profile of patients with primary hyperparathyroidism (PHPT) and urolithiasis. Patients and Methods We analysed the prospectively collected charts of patients treated at our stone clinic between January 2001 and January 2016 searching for patients with PHPT and urolithiasis. Imaging evaluation of the kidneys, bones and parathyroid glands was assessed. We analysed the demographic data, serum and urinary variables before and after parathyroidectomy. We used a paired t-test, Fisher's test, Spearman's test and ANOVA in the statistical analysis. Results A total of 51 patients were included. The mean patient age was 57.1 +/- 12.1 years and 82.4% were women. Before parathyroidectomy, mean calcium and parathyroid hormone (PTH) levels were 11.2 +/- 1.0 mg/dL and 331 +/- 584 pg/dL, respectively. Hypercalcaemia was present in 84.3% of patients. All eight patients with normal calcium levels had elevated PTH levels. Only two patients did not have PTH above the normal range, although both had elevated calcium levels. The most common urinary disorders were low urinary volume (64.7%), hypercalciuria (60.8%), high urinary pH (41.2%) and hypocitraturia (31.4%). After parathyroidectomy, the number of patients with hypercalcaemia (n = 4; 7.8%), elevated PTH (n = 17; 33.3%) and hypophosphataemia (n = 3; 5.9%) significantly decreased (P < 0.001). The number of urinary abnormalities decreased and there was a reduction in urinary calcium (P < 0.001), pH (P = 0.001) and citrate levels (P = 0.003). Conclusion Individuals with PHPT and nephrolithiasis frequently have elevated baseline PTH and calcium levels. Low volume, hypercalciuria, high urinary pH, and hypocitraturia are the most frequent urinary disorders. Parathyroidectomy is effective in normalizing serum calcium and PTH levels, although other urinary metabolic may persist. Patients should be monitored for the need for citrate supplementation.
引用
收藏
页码:281 / 288
页数:8
相关论文
共 32 条
[1]  
Amaral LM, 2012, J OSTEOPOROS, V3, P128
[2]   Patients With Primary Hyperparathyroidism - Why Do Some Form Stones? [J].
Berger, Aaron D. ;
Wu, Wilfred ;
Eisner, Brian H. ;
Cooperberg, Matthew R. ;
Duh, Quan-Yang ;
Stoller, Marshall L. .
JOURNAL OF UROLOGY, 2009, 181 (05) :2141-2145
[3]   Clinical Spectrum of Primary Hyperparathyroidism [J].
Bilezikian J.P. ;
Silverberg S.J. .
Reviews in Endocrine and Metabolic Disorders, 2000, 1 (4) :237-245
[4]  
Bilezikian John P., 2006, Arq Bras Endocrinol Metab, V50, P647, DOI 10.1590/S0004-27302006000400010
[5]   Guidelines for the Management of Asymptomatic Primary Hyperparathyroidism: Summary Statement from the Third International Workshop [J].
Bilezikian, John P. ;
Khan, Aliya A. ;
Potts, John T., Jr. .
JOURNAL OF CLINICAL ENDOCRINOLOGY & METABOLISM, 2009, 94 (02) :335-339
[6]   Primary hyperparathyroidism: new concepts in clinical, densitometric and biochemical features [J].
Bilezikian, JP ;
Brandi, ML ;
Rubin, M ;
Silverberg, SJ .
JOURNAL OF INTERNAL MEDICINE, 2005, 257 (01) :6-17
[7]   IMPORTANCE OF CIRCULATING 1,25-DIHYDROXYVITAMIN-D IN THE PATHOGENESIS OF HYPERCALCIURIA AND RENAL-STONE FORMATION IN PRIMARY HYPERPARATHYROIDISM [J].
BROADUS, AE ;
HORST, RL ;
LANG, R ;
LITTLEDIKE, ET ;
RASMUSSEN, H .
NEW ENGLAND JOURNAL OF MEDICINE, 1980, 302 (08) :421-426
[8]   Risk factors associated to kidney stones in primary hyperparathyroidism [J].
Corbetta, S ;
Baccarelli, A ;
Aroldi, A ;
Vicentini, L ;
Fogazzi, GB ;
Eller-Vainicher, C ;
Ponticelli, C ;
Beck-Peccoz, P ;
Spada, A .
JOURNAL OF ENDOCRINOLOGICAL INVESTIGATION, 2005, 28 (02) :122-128
[9]   Diagnosis of Asymptomatic Primary Hyperparathyroidism: Proceedings of the Third International Workshop [J].
Eastell, R. ;
Arnold, A. ;
Brandi, M. L. ;
Brown, E. M. ;
D'Amour, P. ;
Hanley, D. A. ;
Rao, D. Sudhaker ;
Rubin, M. R. ;
Goltzman, D. ;
Silverberg, S. J. ;
Marx, S. J. ;
Peacock, M. ;
Mosekilde, L. ;
Bouillon, R. ;
Lewiecki, E. M. .
JOURNAL OF CLINICAL ENDOCRINOLOGY & METABOLISM, 2009, 94 (02) :340-350
[10]  
Ekane S, 1997, Acta Urol Belg, V65, P1