¿Son válidos los criterios quirúrgicos actuales del hiperparatiroidismo primario asintomático?

Abstract

SummaryHPTP is a very frequent pathology which often develops asymptomatically. Surgical intervention being the only curative treatment for this disease there are some criteria for the indication of surgery, but these do not always fit the reality of the patient since they are based on clinical complications (osteoporosis, renal insufficiency, urolithiasis, fragility fractures). We present the clinical case of a patient who did not meet any of the requirements for having surgical intervention according to the position documents, and who was operated on after the existence was shown of a deterioration of the trabecular bone structure, determined by the TBS (trabecular bone score) technique, and located in the adenoma using gammagraphy. The possible use of these techniques, not seen in the position documents, to complement the decision regarding surgery, is discussed.

Trabecular Bone Score y tratamiento quirúrgico del hiperparatiroidismo primario

“…However, no surgical criteria have been established as a function of the value of TBS due to its limited availability at the current time, although it is recognised that this may change in the future. The clinical case presented by Fernández-SanMillán et al 3 features a woman of 57 years of age in whom, in spite of not meeting the criteria for surgery according to the different recommendations, it was decided to perform a parathyroidectomy in response to the existence of a deterioration in trabecular bone structure determined by TBS and after locating an adenoma by gammagraphy. After surgery, an improvement in bone mineral density, and in markers for bone remodelling, were observed.…”