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Der Chirurg

, Volume 88, Issue 12, pp 1069–1080 | Cite as

Diagnostik und Therapie des primären Hyperparathyreoidismus

CME
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Zusammenfassung

Der primäre Hyperparathyreoidismus ist eine Erkrankung, die häufiger als allgemein angenommen vorkommt und oft übersehen wird. Klassische Symptome sind Knochenschmerzen und Osteoporose, Nierensteine und peptische Ulzera. Viele Patienten sind asymptomatisch oder haben unspezifische Beschwerden. Die biochemische Diagnostik ist einfach und basiert auf der Bestimmung der Serumspiegel von Kalzium und Parathormon (PTH) sowie der Kalziumausscheidung im 24-Stunden-Urin. Mit Sonographie und Tc-99m-MIBI-Szintigraphie lassen sich Nebenschilddrüsenadenome am besten lokalisieren. Bei symptomatischen Patienten ist die Operationsindikation unstrittig, bei Patienten ohne klassische Symptome wird sie teilweise kontrovers beurteilt. Die operative Therapie ist in einem hohen Maße erfolgreich. Neben der 4‑Drüsen-Exploration stehen heute fokussierte Operationsverfahren zur Verfügung. Dabei muss der Operationserfolg intraoperativ durch die Bestimmung des PTH-Spiegels überprüft werden.

Schlüsselwörter

Operationsindikation Parathormon Lokalisationsdiagnostik Quick-PTH-Assay Parathyreoidektomie 

Diagnostics and treatment of primary hyperparathyroidism

Abstract

Primary hyperparathyroidism is a disease that occurs more frequently than generally thought and is often overlooked. Classical symptoms are bone pain and osteoporosis, renal calculi and peptic ulcers. Many patients are asymptomatic or have unspecific complaints. It is easy to establish the biochemical diagnosis based on calcium and parathormone (PTH) levels and 24-h urine calcium excretion. The most sensitive localization procedures for parathyroid adenomas are sonography and Tc-99m-MIBI scintigraphy. The indication for surgery is undisputed in symptomatic patients; however, there is controversy concerning patients without classical symptoms. Operative therapy is highly successful. Focused operative procedures are currently available besides the traditional 4‑gland exploration. When focused techniques are used, the operative success should be confirmed by intraoperative determination of the parathormone level.

Keywords

Surgical indication Parathormone Localization procedures Quick PTH assay Parathyroidectomy 

Notes

Einhaltung ethischer Richtlinien

Interessenkonflikt

C. Nies gibt an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

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Copyright information

© Springer Medizin Verlag GmbH 2017

Authors and Affiliations

  1. 1.Klinik für Allgemein- und ViszeralchirurgieNiels-Stensen-Kliniken, Marienhospital OsnabrückOsnabrückDeutschland

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