부갑상선 기능항진증을 동반한 부갑상선 선종에 대한 임상적 고찰

Abstract

BACKGROUND AND OBJECTIVES: With the recent introduction of a routine calcium screening, the incidence of parathyroid adenoma, a rare disease but also the most frequent cause of primary hyperparathyroidism, has increased. The increased incidence, however, has not been met readily by ENT surgeons since the clinical symptoms, diagnostic and operative techniques of the disease are not familiar to them. The purpose of this study was to assess the clinical characteristics, effectiveness of preoperative localization test and surgical outcomes of parathyroid adenoma with primary hyperparathyroidism. SUBJECTS AND METHOD: Ten consecutive cases of parathyroid adenoma with hyperparathyroidism surgically treated from Jun. 2001 through Jan. 2005 were included in this study. Preoperative localization test was performed with combinations of radionuclide parathyroid scan, ultrasonography and CT scan. Intact parathyroid hormone (iPTH), total calcium, phosphate, alkaline phosphatase were checked before and after surgery. RESULTS: The clinical manifestations were osteoporosis (90%), neuromuscular symptoms (70%), peptic ulcer (60%), ureter stone (60%) and renal stone (40%) in order of frequency. Diagnosis was delayed in most of the patients for 1 to 9 months because of their nonspecific symptoms. Sensitivities of parathyroid scan, neck ultrasonography and neck CT as preoperative localization test were 80%, 85.7% and 80%, respectively. The most common postoperative complication was temporary hypocalcemia due to hungry bone syndrome. It was easily corrected by calcium and vitamin D supplements. CONCLUSION: We reconfirmed that parathyroid adenoma with hyperparathyroidism needed to be presented as a systemic disease with numerous clinical features, and therefore, a team approach involving an endocrionolgist would be essential. Surgical treatment via unilateral approach for preoperatively localized single parathyroid adenoma was successful without any complications, but a prospective randomized study is needed.