title: [Surgical therapy of primary hyperparathyrodism in the context of orthopaedic diagnosis and treatment: our experiences in 441 patients].
abstract: OBJECTIVE
  Primary hyperparathyroidism is an endocrine disorder affecting calcium and phosphate metabolism. It is surgically treated by removing hyperfunctional parathyroid tissue. The aim of the study was to show, based on surgical results, that the introduction of serum calcium screening in orthopaedic therapy is effective. The detection of hypercalcemia and diagnosis of primary hyperparathyroidism allow for a good timing of endocrine surgery in relation to an orthopaedic procedure.
  
  
  METHODS
  This retrospective study included 441 patients in the age range of 18 to 83 years who underwent parathyroidectomy between 2004 and 2007. Skeletal disorders were diagnosed by clinical, radiographic and densitometric examination; calcium levels were measured after surgery. Bone repair after parathyroidectomy was followed up by the endocrinologist for 1 year.
  
  
  RESULTS
  Before surgery, 48 % of the patients had skeletal disorders. Adenoma was found in 87 %, double adenoma in 2 %, hyperplasia in 10 % and parathyroid carcinoma in 0.5 % of the patients. Complications involved transient paresthesia of the recurrent laryngeal nerve (1 %), transient hypocalcemia (0.5 %), transient post-operative arrhythmias (0.5 %), temporary psychological problems (0.7 %) and post-operative bleeding (0.5 %). None of the patients died. Serum calcium levels were as follows: 2.90 ± 0.01 mmol/L pre-operatively; 2.44 ± 0.01 mmol/L on the evening of surgery; 2.30 ±0.01 mmol/L on the 1st day; 2.19 ± 0.01 mmol/L on the 2nd day; and 2.18 ± 0.01 mmol/L on the 3rd post-operative day. On the 3rd post-operative day most of the patients were discharged from the hospital. Normal calcium levels were achieved in 98 % of the surgically treated patients.
  
  
  CONCLUSIONS
  The study provides evidence for the efficiency of calcium screening in primary hyperparathyroidism and shows the feasibility of involving endocrine surgery in the course of orthopaedic treatment.
authors: III. chirurgická klinika 1. LF UK a FN Motol, Prague.
authors: S
authors: S
authors: Adámek
authors: P
authors: P
authors: Libánský
authors: R
authors: R
authors: Lischke
authors: R
authors: R
authors: Foltán
authors: J
authors: J
authors: Kubinyi
authors: P
authors: P
authors: Broulík
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001851:Bone Diseases, Metabolic / Q000175:diagnosis* / Q000209:etiology; D005260:Female; D006801:Humans; D006934:Hypercalcemia / Q000209:etiology; D049950:Hyperparathyroidism, Primary / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D016105:Parathyroidectomy; D055815:Young Adult