Zusammenfassung
Der primäre Hyperparathyreoidismus (pHPT) ist eine häufige endokrine Erkrankung, deren Inzidenz deutlich ansteigt. Neben den klassischen Symptomen wie Knochenschmerzen, Osteoporose und Nierensteinen stehen oft unspezifische Beschwerden wie Antriebslosigkeit und Erschöpfung sowie auch Angstzustände und depressive Symptome im Vordergrund. Die Diagnose ist einfach und erfolgt durch Bestimmung der Serumspiegel von Kalzium und Parathormon (PTH). Mittels Sonographie und Tc-99m-MIBI-Szintigraphie kann dann ein Großteil der Nebenschilddrüsenadenome lokalisiert werden. Schon beim laborchemischen Nachweis ist die Operationsindikation in aller Regel indiziert. Die Operation ist die einzige kurative Therapie des pHPT. Sie ist in der Regel erfolgreich. Neben der bilateralen Exploration kann die Operation auch fokussiert geplant werden. Dabei kann der Operationserfolg intraoperativ durch die Bestimmung des intraoperativen Quick-PTH (IOPTH) dokumentiert werden.
Abstract
Primary hyperparathyroidism (pHPT) is a frequent endocrine disease, the incidence of which is clearly increasing. In addition to the classical symptoms of bone pain, osteoporosis and renal calculi, nonspecific complaints, such as listlessness and exhaustion, anxiety states and depressive symptoms also often occur. The diagnosis is simple and is carried out by determination of calcium and parathormone (PTH) serum levels. The majority of parathyroid adenomas can be localized by ultrasound and Tc-99m-MIBI scintigraphy. The indications for surgery can normally already be identified by the laboratory biochemical detection. Surgery is the only curative treatment of pHPT and is normally successful. In addition to bilateral exploration, a focused parathyroidectomy can be planned. The success of surgery can be intraoperatively documented by the determination of intraoperative Quick PTH (IOPTH).
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Fendrich, V., Zahn, A. Lokalisationsdiagnostik und Operationsstrategie beim Ersteingriff bei sporadischem primärem Hyperparathyreoidismus. Chirurgie 94, 573–579 (2023). https://doi.org/10.1007/s00104-023-01868-z
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DOI: https://doi.org/10.1007/s00104-023-01868-z
Schlüsselwörter
- Nebenschilddrüsenadenom
- Ultraschall
- Tc-99m-MIBI-Szintigraphie
- Fokussierte Parathyreoidektomie
- Bilaterale Exploration