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Revue du rhumatisme
Volume 71, n° 5
pages 343-349 (mai 2004)
Doi : 10.1016/j.rhum.2003.09.026
Received : 6 May 2003 ;  accepted : 10 September 2003
Hyperparathyroïdie primitive et ostéoporose en 2004
Primary Hyperparathyroidism and Osteoporosis in 2004 " onClick="javascript:init_clueTip($j(this));" rel=".tooltip-art-idFN0">

Catherine  Cormier a * ,  Jean-Claude  Souberbielle b ,  André  Kahan a
aService de rhumatologie A, 27, rue du Faubourg-Saint-Jacques, hôpital Cochin, Paris, France 
bService d'explorations fonctionnelles, hôpital Necker, Paris, France 

*Auteur correspondant.
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La certitude du diagnostic d'hyperparathyroïdie primitive (HPP) est la première étape avant toute décision de prise en charge. Elle repose sur un diagnostic biologique guidé par des dosages adaptés et bien interprétés. La pratique, de plus en plus répandue, de dosage de PTH devant une ostéoporose est souvent responsable de tableau biologique compatible avec le diagnostic d'HPP mais d'interprétation difficile. La mesure de la DMO, dans l'évaluation du retentissement d'une HPP, et la réévaluation en 2003 à la baisse de son seuil pour décider d'une parathyroïdiectomie rend plus fréquente l'indication opératoire. La parathyroïdectomie reste le traitement privilégié du fait d'une faible mortalité et de l'absence d'alternative médicamenteuse utilisable sur de longues durées.

Mots clés  : Hyperparathyroïdisme primaire ; Ostéoporose.

Abstract

In patients with primary hyperparathyroidism, a definite diagnosis is the first step in the management strategy and relies on appropriately selected and carefully interpreted laboratory tests. Parathyroid hormone assays are being increasingly performed as part of the routine evaluation of osteoporosis. In this setting, laboratory tests are often consistent with primary hyperparathyroidism but should be interpreted with caution. Bone mineral density measurements are useful for assessing the impact of primary hyperparathyroidism. The recommended bone mineral density cutoffs for selecting patients requiring parathyroidectomy were lowered in 2003, and the number of surgically treated patients has increased as a result. Parathyroidectomy remains the treatment of choice given the low mortality associated with this procedure and the absence of pharmacological alternatives suitable for long-term use.

Mots clés  : Primary hyperparathyroidism ; Osteoporosis.


  Pour citer cet article, utiliser ce titre en anglais et sa référence dans le même volume de Joint Bone Spine




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