中华内分泌代谢杂志
中華內分泌代謝雜誌
중화내분비대사잡지
CHINESE JOURNAL OF ENDOCRINOLOGY AND METABOLISM
2011年
9期
743-745
,共3页
杜娟%宋怡%王立群%魏丽晶
杜娟%宋怡%王立群%魏麗晶
두연%송이%왕립군%위려정
三发性甲状旁腺功能亢进症%诊断
三髮性甲狀徬腺功能亢進癥%診斷
삼발성갑상방선공능항진증%진단
Tertiary hyperparathyroidism%Diagnosis
目的 总结三发性甲状旁腺功能亢进症的病例特点及诊断思路。方法 回顾分析三发性甲状旁腺功能亢进症患者7例。收集首发症状、病程、既往史、骨及关节平片、骨密度、骨SPECT、血常规、血钙、血磷、碱性磷酸酶、甲状旁腺素（PTH）、甲状旁腺超声或甲状旁腺CT、甲状旁腺锝99显像和甲状旁腺病理等资料。结果 骨骼疼痛为首发症状6例，其中1例伴多饮，骨折1例。既往患胆囊结石或泌尿系结石4例，骨及关节平片和骨密度提示骨质疏松4例，其中2例发生骨折。7例患者血钙和PTH水平均升高，6例血磷降低，6例碱性磷酸酶升高。彩超或CT提示甲状旁腺增生5例，锝99显像提示甲状旁腺增生伴高功能结节3例。手术后甲状旁腺病理提示甲状旁腺腺瘤5例，甲状旁腺腺癌1例，1例未手术。手术后6例患者血钙降低，补钙10～15d后恢复正常，PTH恢复正常。结论有骨痛、骨质疏松、骨折等症状，既往有结石病史，同时伴有高血钙、高PTH水平者应考虑继发性甲状旁腺功能亢进的可能。明确诊断依靠病理结果。
目的 總結三髮性甲狀徬腺功能亢進癥的病例特點及診斷思路。方法 迴顧分析三髮性甲狀徬腺功能亢進癥患者7例。收集首髮癥狀、病程、既往史、骨及關節平片、骨密度、骨SPECT、血常規、血鈣、血燐、堿性燐痠酶、甲狀徬腺素（PTH）、甲狀徬腺超聲或甲狀徬腺CT、甲狀徬腺锝99顯像和甲狀徬腺病理等資料。結果 骨骼疼痛為首髮癥狀6例，其中1例伴多飲，骨摺1例。既往患膽囊結石或泌尿繫結石4例，骨及關節平片和骨密度提示骨質疏鬆4例，其中2例髮生骨摺。7例患者血鈣和PTH水平均升高，6例血燐降低，6例堿性燐痠酶升高。綵超或CT提示甲狀徬腺增生5例，锝99顯像提示甲狀徬腺增生伴高功能結節3例。手術後甲狀徬腺病理提示甲狀徬腺腺瘤5例，甲狀徬腺腺癌1例，1例未手術。手術後6例患者血鈣降低，補鈣10～15d後恢複正常，PTH恢複正常。結論有骨痛、骨質疏鬆、骨摺等癥狀，既往有結石病史，同時伴有高血鈣、高PTH水平者應攷慮繼髮性甲狀徬腺功能亢進的可能。明確診斷依靠病理結果。
목적 총결삼발성갑상방선공능항진증적병례특점급진단사로。방법 회고분석삼발성갑상방선공능항진증환자7례。수집수발증상、병정、기왕사、골급관절평편、골밀도、골SPECT、혈상규、혈개、혈린、감성린산매、갑상방선소（PTH）、갑상방선초성혹갑상방선CT、갑상방선득99현상화갑상방선병리등자료。결과 골격동통위수발증상6례，기중1례반다음，골절1례。기왕환담낭결석혹비뇨계결석4례，골급관절평편화골밀도제시골질소송4례，기중2례발생골절。7례환자혈개화PTH수평균승고，6례혈린강저，6례감성린산매승고。채초혹CT제시갑상방선증생5례，득99현상제시갑상방선증생반고공능결절3례。수술후갑상방선병리제시갑상방선선류5례，갑상방선선암1례，1례미수술。수술후6례환자혈개강저，보개10～15d후회복정상，PTH회복정상。결론유골통、골질소송、골절등증상，기왕유결석병사，동시반유고혈개、고PTH수평자응고필계발성갑상방선공능항진적가능。명학진단의고병리결과。
Objective To analyze the clinical features of tertiary hyperparathyroidism. Methods The data including symptoms, past history, bone and joint X-ray, bone mass density, bone SPECT, blood routine, serum calcium, phosphorus, alkaline phosphatase, parathyroid hormone ( PTH), as well as parathyroid ultrasonic or CT,parathyroid ECT, and parathyroid pathology were collected from seven patients with tertiary hyperparathyroidism.Results The first symptom in 6 patients was bone ache, one of them was thirsty, and 1 patient had fracture. Four patients had past history of gallbladder stone or renal stone. Four subjects presented with osteoporosis and 2 of them had fractures. All 7 patients suffered from hypercalcaemia, along with high PTH level, 6 with hypophosphataemia and 6 with high alkaline phosphatase level. The enlarged parathyroid glands were detected in five patients by ultrasonic or CT. Tc99 scans of parathyroid gland revealed hyperfunctioning nodes in 3 subjects. Six patients were operated, and pathological results showed adenoma in parathyroid gland in 5 patients and adenocarcinoma in 1 patient. Serum calcium and PTH levels returned to normal in all the operated patients. ConclusionsPatients who present bone ache, osteoporosis, spontaneous fracture, past history of gallbladder stone or renal stone, high serum calcium, and PTH levels, should be aware of the probability of tertiary hyperparathyroidism. The confirmed diagnosis depends on pathological result.
