Hiperparatireoidismo primário
Resumen
Definición
Anamnesis y examen
Principales factores de diagnóstico
- achado incidental em testes bioquímicos
- história de osteoporose ou osteopenia
- história familiar de hiperparatireoidismo ou características sugestivas de hipercalcemia
- nefrolitíase
Otros factores de diagnóstico
- má qualidade do sono
- fadiga
- mialgia
- ansiedade
- depressão
- perda de memória
- disfunção neuromuscular evidente
- disfunção cardiovascular e metabólica
- sintomas gastrointestinais
Factores de riesgo
- sexo feminino
- idade ≥50-60 anos
- neoplasia endócrina múltipla (NEM) 1, 2A ou 4
- histórico ou tratamento atual com lítio
- síndrome do tumor mandibular hiperparatireoidiano
- história familiar de HPTP
- história de irradiação da cabeça e do pescoço
Pruebas diagnósticas
Primeras pruebas diagnósticas para solicitar
- cálcio sérico
- paratormônio (PTH) intacto sérico com ensaio imunorradiométrico ou imunoquímico
Pruebas diagnósticas que deben considerarse
- nível da 25-hidroxivitamina D
- fosfatase alcalina sérica
- fósforo sérico
- cálcio urinário de 24 horas
- exame de absorciometria por dupla emissão de raios X (DEXA)
- escore ósseo trabecular
- ultrassonografia do pescoço
- cintilografia com tecnécio-99m sestamibi
- TC por emissão de fóton único (SPECT)
- tomografia computadorizada (TC) do pescoço
- TC quadridimensional (4D) de pescoço
- ressonância nuclear magnética (RNM) do pescoço
Pruebas emergentes
- PET com colina radiomarcada
- aprendizado de máquina para identificar hiperparatireoidismo primário
Algoritmo de tratamiento
assintomático sem indicações cirúrgicas ou sintomático
assintomático sem indicações cirúrgicas
Colaboradores
Autores
John Ayuk, MD
Consultant Endocrinologist
University Hospitals Birmingham
Birmingham
UK
Disclosures
JA declares that he has no competing interests.
Neil Gittoes, MD, PhD
Consultant Endocrinologist and Honorary Professor of Endocrinology
Associate Medical Director
University Hospitals Birmingham
Birmingham
UK
Disclosures
NG is an author of several references cited in this topic and is a member of the 2021 European Society of Endocrinology Educational Program of Parathyroid Disorders (PARAT) Working Group.
Acknowledgements
Dr John Ayuk and Professor Neil Gittoes would like to gratefully acknowledge Dr Fausto Palazzo, Dr Swaroop Gantela, and Dr Nancy D. Perrier, the previous contributors to this topic. FP, SG, and NDP declare that they have no competing interests.
Peer reviewers
Brendan C. Stack Jr, MD, FACS, FACE
Chairman, Endocrine Surgery Section
American Head and Neck Society
Professor and former inaugural Chairman
Department of Otolaryngology-Head and Neck Surgery
Southern Illinois University School of Medicine
Springfield
IL
Раскрытие информации
BCS declares that he has no competing interests.
Petros Perros, BSc, MBBS, MD, FRCP
Department of Endocrinology
Elliott Building
Royal Victoria Infirmary
Newcastle-upon-Tyne
UK
Раскрытие информации
PP declares that he has no competing interests.
Peer reviewer acknowledgements
BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.
Disclosures
Peer reviewer affiliations and disclosures pertain to the time of the review.
Список литературы
Основные статьи
Bilezikian JP, Khan AA, Silverberg SJ, et al. Evaluation and management of primary hyperparathyroidism: summary statement and guidelines from the fifth International Workshop. J Bone Miner Res. 2022 Nov;37(11):2293-314.Полный текст Аннотация
Wilhelm SM, Wang TS, Ruan DT, et al. The American Association of Endocrine Surgeons guidelines for definitive management of primary hyperparathyroidism. JAMA Surg. 2016 Oct 1;151(10):959-68.Полный текст Аннотация
Bollerslev J, Rejnmark L, Zahn A, et al. European expert consensus on practical management of specific aspects of parathyroid disorders in adults and in pregnancy: recommendations of the ESE educational program of parathyroid disorders. Eur J Endocrinol. 2022 Feb 1;186(2):R33-63.Полный текст Аннотация
Walker MD, Silverberg SJ. Primary hyperparathyroidism. Nat Rev Endocrinol. 2018 Feb;14(2):115-25.Полный текст Аннотация
Petranović Ovčariček P, Giovanella L, Carrió Gasset I, et al. The EANM practice guidelines for parathyroid imaging. Eur J Nucl Med Mol Imaging. 2021 Aug;48(9):2801-2822.Полный текст Аннотация
Статьи, указанные как источники
A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
Отличия
- Hipercalcemia hipocalciúrica familiar (HHF)
- Hipercalcemia humoral de malignidade
- Mieloma múltiplo
Больше ОтличияРекомендации
- ACR–ACNM–SNMMI–SPR practice parameter for the performance of parathyroid scintigraphy
- Practice parameter for the performance and interpretation of diagnostic ultrasound of the thyroid and extracranial head and neck
Больше Рекомендации
Войдите в учетную запись или оформите подписку, чтобы получить полноценный доступ к BMJ Best Practice
Использование этого контента попадает под действие нашего заявления об отказе от ответственности