Üriner sistem taş hastalığı birden fazla etkenli etiyolojiye sahiptir. Primer hiperparatiroidizm tekrarlayan taş hastalığına neden olan etiyolojik etkenlerden birisidir. Bu çalışmada tekrarlayan kalsiyum oksalat taş hastalarında metabolik değerlendirme sonucunda hiperparatiroidizmle kendini gösteren paratiroid adenomu olguları sunulmaktadır.Kliniğimize başvuran 422 primer taş hastasından nüks kabul edilip kalsiyum oksalat taşı saptanan 126 hasta değerlendirmeye alındı. Hastaların tamamına paratiroid hormon analizi ve iki kez 24 saatlik idrar analizi yapıldı. Parathormon yüksekliği belirlenen hastalara paratiroid sintigrafisi ve paratiroid ultrasonografisi yapıldı. Paratiroid adenomu belirlenen hastalar cerrahi tedaviye yönlendirildi.126 tekrarlayan kalsiyum oksalat taş hastasının 15 tanesinde (%11,9) hiperparatiroidizm saptandı. Bu 15 hastanın da 12’inde (11 kadın, 1 erkek) paratiroid adenomu bulundu. Hastaların parathormon seviyesi ortalama 14,8±7,9 pqmol/lt (6,25-25,26) olarak bulundu. Kan analizlerinde 6 hastada (%50) hiperkalsemi, 7 hastada (%58) hipofosfatemi mevcuttu. 24 saatlik idrar analizlerinde temel metabolik bozukluk olarak hiperkalsiüri ve hiperoksalüri (%83) tespit edildi. Hastaların tamamı paratiroid cerrahisine alındı. Cerrahi tedavi sonrası izlemlerde hastaların tamamında hiperkalsemi, hipofosfatemi ve hiperkalsiürinin düzeldiği saptandı.Yayınlarda primer taş hastaları arasında hiperparatiroidizm oranı %1,8 civarında verilmekle birlikte bizim serimizde bu oran primer taş hastaları için %3,5 ve tekrarlayan kalsiyum oksalat taş hastaları için ise %11.9 olarak bulunmuştur. Adenom saptanan hiperparatiroidizm olgularının adenoma yönelik cerrahi tedavi ile taş nükslerinden sorumlu metabolik risk etkenlerinin düzeltilebilmesi mümkün olduğundan, özellikle ciddi hiperkalsiüriye ek olarak hiperkalsemi varlığında paratiroid adenomu mutlaka araştırılmalıdır.
Introduction: Urinary stone disease has a multifactorial etiology. Primary hyperparathyroidism is one of the etiological factors those causes recurrent stone disease. In patients with recurrent calcium oxalate stone, frequent causes of hyperparathyroidism are parathyroid gland adenoma and cancer. The purpose of this study was to identify the etiological factors in patients with recurrent calcium oxalate stone, and to examine the incidence of parathyroid adenoma in those patients who also had hyperparathyroidism.Materials and Methods: 422 primary stone patients who attended to our department were evaluated and urinary stones were analyzed in all patients. 126 patients with calcium oxalate stone were accepted as recurrent calcium-oxalate stone patients and were included in the study. Serum parathyroid hormone levels were evaluated and 24-hour urine analyses were studied two times in all patients. Diet modifications were prescribed for patients whose urine analysis parameters were abnormal. Patients with elevated serum parathyroid hormone levels underwent parathyroid scintigraphy and parathyroid ultrasonography. Patients who had parathyroid adenoma were underwent surgical treatment.Results: Hyperparathyroidism was detected in 15 (11.9%) of 126 recurrent calcium-oxalate stone patients, parathyroid adenoma was identified in 12 (11 female, 1 male) of these 15 patients. The mean PTH level was detected as 14.8±7.9 pqmol/lt (6.25-25.26). In blood analysis hypercalcemia and hypophosphatemia were detected in 6 (50%) and 7 (58%) patients, respectively. Hypercalciuria and hyperoxaluria (83%) were detected as the main metabolic abnormality in 24-hour urine analysis. All patients underwent parathyroid surgery. Hypercalcemia, hypophosphatemia and hypercalciuria were improved after surgical treatment.Conclusion: Although hyperparathyroidism rate has been reported about 1.8% in the primary stone patients in the literature, we identified that this rate was 3.5% in the primary stone patients and 11.9% in recurrent stone patients. The risk factors that are responsible for recurrent stone disease could be treated with the surgical treatment of parathyroid adenoma, which lead to hyperparathyroidism, thus parathyroid adenoma should be kept in mind in patients especially who had severe hypercalciuria in addition to hypercalcemia.
