Determinação do Ponto de Corte de PTH para a Diferenciação entre Hiperparatireoidismo Primário e Carcinoma de Paratireoide: Uma Revisão integrativa de Literatura
DOI:
https://doi.org/10.36557/2674-8169.2025v7n5p478-503Keywords:
Primary Hyperparathyroidism, Parathyroid Carcinoma, Parathyroid HormoneAbstract
Introduction: Primary hyperparathyroidism (HPTP), prevalent in 1-7 per 1,000 adults, results from excessive parathyroid hormone (PTH) secretion, caused by adenomas (85-90%) or parathyroid carcinoma (CP, <1%). PTH regulates serum calcium, but its elevation causes hypercalcemia, with bone, renal, and neurological symptoms. Differentiating HPTP from CP is challenging due to clinical similarities. Methodology: Integrative review searched studies (2020-2024) in BVS, PubMed, and SciELO, using descriptors “Hyperparathyroidism,” “Parathyroid Hormone,” and “Parathyroid Carcinoma.” Articles in Portuguese or English on PTH in HPTP and CP were included, excluding theoretical or methodologically flawed studies. Two researchers selected 12 studies after quality assessment, extracting data and analyzing via ROC curve. Results: The 12 studies show elevated PTH in CP (mean 1,738.7 pg/mL) compared to adenomas (211.4 pg/mL). The Ca/P × PTH index distinguishes metabolic disorders with high sensitivity (84.7-88.9%). Parathyroidectomy with intraoperative monitoring (ioPTH) achieves 81.3-100% accuracy, normalizing PTH and calcium. PTH is a key marker in pathological fractures and pregnancy. Discussion: PTH is critical for differential diagnosis, but the lack of universal cutoffs, due to assay variations and comorbidities, limits its application. Combined indices and ioPTH enhance diagnostic accuracy. Contexts like pregnancy and intrathyroidal CP highlight its relevance, though standardization is needed. Conclusion: PTH above 1,000 pg/mL suggests CP, with parathyroidectomy as an effective treatment. Gaps include the lack of multicenter studies and assay standardization. Future research could explore artificial intelligence to refine cutoffs.
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Copyright (c) 2025 Caio Victor Fernandes de Oliveira, Roberto Fagner Felix Araujo, Diógenes Emanuel Dantas da Silva , José Roery da Silva Pires, Maria Eduarda de Sousa Monteiro, Maria Layane da Silva Lima, Rafael Palmeira Araujo Medeiros Nóbrega, Maria Luisa Cavalcante Fonseca, Fabrícia dos Santos Almeida, Heverly Dayane da Silva Santos, Alcebíades José dos Santos Neto
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