| Abstract | Ciljevi istraživanja: primarni je cilj ovoga istraživanja određivanje udjela sekundarnog hiperparatireoidizma među pacijentima koji su kirurški liječeni zbog primarnog ili sekundarnog hiperparatireoidizama. Prikazani su svi bolesnici kirurški liječeni zbog primarnog ili sekundarnog hiperparatireoidizma. Prikazali smo i njihovu prosječnu dob, spolnu raspodjelu, etiologiju hiperfunkcije paratireoidnih žlijezda, vrijeme hospitalizacije nakon operacije i prosječne razine kalcija prije i treći dan nakon kirurškog liječenja.
Materijali i metode: Ovo retrospektivno presječno istraživanje uključuje 147 bolesnika oboljelih od primarnog hiperparatiroidizma i 9 bolesnika oboljelih od sekundarnog hiperparatireoidizama koji su kirurški liječeni u Klinici za bolesti uha, nosa i grla s kirurgijom glave i vrata Kliničkog bolničkog centra Split u razdoblju od 2017. do 2021. godine. Podaci o liječenima prikupljeni su pregledom: knjige protokola operiranih, arhiva Klinike i Bolničkog informatičkog sustava. Podaci o: dijagnozi hiperparatireoidizma, etiologiji sekundarnog hiperparatireoidizma, dobi, spolnoj raspodjeli, lokalizaciji uklonjene žlijezde, incidenciji po godinama, razinama kalcija u serumu prije i treći dan nakon kirurškog liječenja obradili smo deskriptivnim statističkim metodama te su rezultati prikazani grafički i tablično.
Rezultati: U spomenutom razdoblju u navedenoj Klinici kirurški je liječeno 147 pacijenata s dijagnozom primarnog i 9 pacijenata s dijagnozom sekundarnog hiperparatireoidizma. Udio sekundarnog hiperparatireoidizma je 5,77%. Uočen je pad broja operiranih pacijenata u 2020. godini. Među pacijentima s primarnim hiperparatireoidizmom 83,67% su žene, a 16,33% muškarci. Prosječna dob pacijenata s primarnim hiperparatireoidizmom je 60,7 godina. Solitarni je adenom uzrok primarnog hiperapratireoidizma u 94,56% slučajeva, multipli adenom u 4,76 slučajeva, a karcinom u 0,68% slučajeva. Najčešća lokalizacija adenoma ili karcinoma je donja lijeva doštitna žlijezda (51,95%), zatim donja desna doštitna žlijezda (37,01%), potom gornja desna (7,14%) i na kraju gornja lijeva (3,9%). Povišenu razinu kalcija u serumu prije kirurškog liječenja primarnog hiperparatireoidizma imalo je 92,52% liječenih, a 3. dan nakon operacije razinu serumskog kalcija u referentnom intervalu imalo je 85,71% liječenih. Etiologija sekundarnog hiperparatireoidizma je renalna insuficijencija u 100% slučajeva. Prosječna dob bolesnika sa sekundarnim hiperparatireoidizmom je 53,3 godine. Među kirurški liječenima zbog sekundarnog hiperparatireoidizma 55,56% su muškarci, a 44,44% su žene. Prosječna razina serumskog kalcija u kirurški liječenih pacijenata s primarnim hiperparatireoidizmom prije operacije je bila 2,76 mmol/L, a treći dan nakon operacije 2,28 mmol/L. Prosječna razina serumskog kalcija prije operacije u kirurški liječenih pacijenata zbog sekundarnog hiperparatireoidizma je bila 2,5 mmol/L, a treći dan nakon operacije je bila 2,03 mmol/L. Prosječna duljina trajanja hospitalizacije nakon operacije je 4,67 dana za oboljele od primarnog hiperparatireoidizma, odnosno 5,76 dana za oboljele od sekundarnog hiperparatireoidizma.
Zaključci: Udio kirurški liječenih bolesnika zbog sekundarnog hiperparatireoidizma unutar pacijenata kirurški liječenih zbog primarnog ili sekundarnog manji je od 10%, daleko najčešći uzrok sekundarnog hiperparparatireoidizma je renalna insuficijencija. Za primarni hiperparatireoidizam vrijedi da je većina pacijenata ženskog spola u 6. ili 7. desetljeću života, najčešće sijelo neoplazme je donja lijeva paratireoidna žlijezda te je razina kalcija u serumu u referentnom intervalu trećeg postoperativnog dana za većinu pacijenata. |
| Abstract (english) | Objectives: The goal of this study is to present proportion of surgically treated patients with secondary hyperparathyroidism within patients suffering from primary or secondary hyperparathyroidism. We also presented etiology of hyperparathyroidism, gender and age distribution, duration of hospitalization after surgical treatment and average calcium blood level before and third day after surgical tratment.
Materials and methods: This retrospective cross-sectional study includes 147 surgically treated patients suffering from primary hyperparathyroidism and 9 surgically treated patients suffering from secondary hyperparathyroidism at the Clinic for Ear, Nose and Throat Diseases with Head and Neck Surgery, University Hospital of Split from 2017 to 2021. The data about subjects was reached from the archives of the Clinic and by inspection of Hospital informatical system. Data on diagnosis of hyperparathyroidism, incidence, age, sex, ethiology, localization of neoplasm, duration of hospitalisation and calcium blood levels before and the third day after the surgical procedure was processed by descriptive statistical methods and the results were shown in the form of tables and graphs.
Results: In this 5 year span 147 patients with primary hyperparathyroidism and 9 patients with secondary hyperparathyroidism were surgically treated in the mentioned Clinic. Proportion of secondary hyperparathyroidism is 5.77%. It is visible reduction of surgically treated patients in year 2020. Within patients suffering from primary hyperparathyroidism 83.67% are women, 16.33% are men. Average age is 60.7 years. Solitary adenoma is cause of primary hyperparathyroidism in 94.56% cases, multiple adenoma is cause in 4,76% cases and carcinoma is cause in 0.68% cases. The most often localization of adenoma or carcinoma is left inferior parathyroid gland with 51.95% cases, next one is right inferior parathyroid gland with 37.01% cases, then is right superior with 7.14% cases and left superior with 3.9% cases. 92.52% of surgically treated patients with primary hyperparathyroidism had elevated calcium blood level before surgical treatment. Third postoperative day 85.71% of patients had calcium blood level within reference interval. Ethiology of secondary hyperparathyroidism was renal insufficiency in 100% cases. Average age of patients suffering from secondary hyperparathyroidism was 53.3 years. Within patients surgically treated cause of secondary hyperparathyroidism 55.56% were men and 44.44% were women. Average calcium blood level of patients with primary hyperparathyroidism before surgical treatment was 2.76 mmol/L and third day after surgery that level was 2.28 mmol/L. Average calcium blood level of patients with secondary hyperparathyroidism before surgery was 2.5 mmol/L and third day after surgery it was 2.03 mmol/L. Average duration of hospitalisation after surgery was 4.67 days for patients treated cause of primary hyperparathyroidism and 5.76 days for patients treated cause of secondary hyperparathyroidism.
Conclusions: Proportion of patients treated cause of secondary hyperparathyroidism within surgically treated patients cause of primary or secondary hyperparathyroidism is less than 10% and the most often cause of secondary hyperparathyroidism is renal insufficiency. It stands for primary hyperparathyroidism that the most of the patients are women in a 6th or 7th decade of life, left inferior parathyroid gland is the most common location of neoplasm and calcium blood level is within reference interval the third day after surgery for most patients. |
