科研之友
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摘要
Objective: To refine the diagnostic criteria for primary hyperparathyroidism (1 degrees HPT) to identify atypical patients, in whom serum calcium, parathyroid hormone (PTH), or both are within the %26quot;normal%26quot; range. %26lt;br%26gt;Methods: Total serum calcium, intact PTH, and 25-hydroxyvitamin D [25(OH)D] levels were measured in patients with 1 degrees HPT and healthy patient groups. Multivariate analysis of healthy patient data first identified factors that significantly affected PTH levels and defined a new PTH reference range with a mathematical model. That nomogram was then validated for prediction of atypical 1 degrees HPT in patients with surgically confirmed disease. %26lt;br%26gt;Results: On multivariate analysis, calcium (P = .0002), 25(OH)D (P %26lt;.0001), and age (P = .015) independently affected PTH. With these variables, we created a 4-dimensional nomogram that distinguished normal patients from those with hyperparathyroid states. Mathematically, this nomogram predicts 1 degrees HPT when the measured serum PTH value is higher than PTH calculated by the following formula: PTH (pg/mL) = 120 - [6 x calcium (mg/dL)] - [0.52 x 25(OH)D (ng/mL)] + [0.26 x patient age (years)]. When applied to our surgical group of patients, this nomogram successfully identified 100% of patients (238 of 238) with classic 1 degrees HPT, 84% (64 of 76) with normocalcemic 1 degrees HPT, and 54% (20 of 37) with 1 degrees HPT and normal PTH. %26lt;br%26gt;Conclusion: This study uniquely defines a patient-specific upper limit of normal for PTH based on the readily available variables of serum calcium, 25(OH)D, and patient age. Our nomogram may allow for more rapid definitive diagnosis and treatment of 1 degrees HPT in patients with atypical presentations. (Endocr Pract. 2012;18:124-131)
- 出版日期2012-4
