Procena uticaja paratiroidektomije na kvalitet života pacijenata sa primarnim asimptomatskim hiperparatiroidizmom

Abstract

Uvod Primarni hiperparatiroidizam (pHPT) predstavlja endokrinološki poremećaj metabolizma kalcijuma, sa hiperkalcemijom i povišenim ili neadekvatno normalnim koncentracijama paratiroidnog hormona (PTH). Najčešći je uzrok hiperkalcemije u opštoj populaciji. Jedini trajni način lečenja je operativni. Pored tipičnih kliničkih simptoma, pHPT je povezan i sa narušenim kvalitetom života i kognitivnim statusom. Iz tog razloga je cilj ove studije da ispita da li postoji razlika u kvalitetu života i kognitivnim funkcijama kod osoba sa asimptomatskim primarnim hiperparatiroidizmom pre i posle paratiroidektomije. Kao drugi cilj ove studije je identifikacija nezavisnih faktora koji utiču na kvalitet života i kognitivne funkcije osoba sa asimptomatskim primarnim hiperparatiroidizmom. Materijal i metode Sprovedena je panel studija u Centru za endokrinu hirurgiju Klinike za endokrinologiju, dijabetes i bolesti metabolizma Kliničkog centra Srbije (CEH KCS) u periodu od 2014. do 2017. godine. Studijom su obuhvaćeni pacijenti sa novootkrivenim primarnim hiperparatiroidizmom kojima je indikovana paratiroidektomija. Kriterijumi za uključivanje u studiju su dijagnoza asimptomatskog pHPT, stariji od 18 godina, bez prethodne operacije na paratiroidnim žlezdama, nivo serumskog kalcijuma preko 2,65 mmol/L i PTH preko 65 pg/mL. Kriterijumi za isključivanje su simptomatske forme pHPT, sekundarne forma HPT, ostali uzroci hiperkalcemije. Prikupljeni su osnovni demografski i klinički podaci o bolesti. Procena kvaliteta života i neurokognitivnog statusa sprovedena je putem intervjua pre operacije, kao i posle prvog i šestog meseca od operacije...

NTRODUCTION Primary hyperparathyroidism (pHPT) represents an endocrine disorder of calcium metabolism, which presents with hypercalcemia and elevated or inappropriately normal concentrations of parathyroid hormone (PTH). PHPT is the most common cause of hypercalcemia in the general population, and surgery represents the only permanent treatment method. Besides typical clinical symptoms, pHPT may also be associated with poor quality of life and impaired cognitive status. Thus, the primary aim of the present study was to assess whether there is a difference in the quality of life and cognitive status in patients with an asymptomatic pHPT before and after parathyroidectomy. The second objective was to identify independent factors that affect the quality of life and cognitive functions in patients with asymptomatic pHPT. MATERIALS AND METHODS Between 2014 and 2017, a panel study was conducted at the Center for Endocrine Surgery of the Clinic for Endocrinology, Diabetes, and Metabolic Diseases of the Clinical Center of Serbia. The study included patients with newly diagnosed asymptomatic primary hyperparathyroidism in whom parathyroidectomy was indicated, older than 18 years, without previous surgery on the parathyroid glands, with serum calcium level over 2.65 mmol/L and PTH level over 65 pg/mL. Patients with symptomatic forms of pHPT, secondary forms of HPT, and other causes of hypercalcemia were excluded from the study. Basic demographic data of interest and relevant clinical data were collected. Quality of life and neurocognitive status were assessed in interviews before surgery, one month, and six months following surgery...