부갑상선 선종과 증식증의 수술적 치료

Abstract

Hyperparathyroidism is commonly seen in adenoma and hyperplasia, and is classified into primary, secondary and tertiary. However, its etiology, pathogenesis, clinical feature and treatment differ from each another. Most primary hyperparathyroidism can be treated by surgical procedures, and the secondary and tertiary hyperparathyroidism can be treated with medication, However, surgical procedures are necessary, if the symptoms persist after taking appropriate medication. This study was undertaken to review the surgical management and postoperative clinical course of three cases of primary and one case of tertiary hyperparathyroidism. Many different preoperative symptoms such as ureteral stone, osteoporosis, gait disturbance and pathologic features were noted during the course of study. Among the imagine studies conducted to localize parathyroid mass, the authors found the parathyroid scan to be most accurate. All four cases underwent surgery which involved removal of only adenoma in two adenoma casesm removal of only enlarged parathyroid gland in one case of hyperplasia with no postoperative, evidence of recurrence, and total parathyroidectomy with autotransplantation in one case of hyperplasia. The hypocalcemia was noted in all four cases after the surgery. Of these four cases, two recovered slowly from hypocalcemia, and one recovered with no symptom of hypocalcemia, but had to take oral calcium and vitamin D for low calcium level. Finally one case with tertiary hyperparathyroidism developed hypocalcemia postoperatively due to chronic renal failure and died of heart failure.