背景:甲状旁腺腺瘤是高钙血症的最常见原因,很少导致高钙血症危象,这是一种不寻常的内分泌急症,需要及时手术切除。
方法:一名67岁的男性入住Euroclinical医院急诊室,雅典,希腊,因为钙水平升高和右侧颈部肿块明显,伴有恶心症状,困倦,以及在我们评估之前增加的六个月的弱点。还观察到肌酐逐渐升高和精神状态下降。最初的实验室研究发现,血清钙(3.6mmol/L)水平严重升高,与原发性甲状旁腺功能亢进引起的高钙血症(HC)和甲状旁腺激素PTH(47.6pmol/L)一致。颈部超声检查(USG)发现了一个大的,甲状腺右叶形状良好的囊性肿块。血清钙浓度为19.5mg/dL,PTH为225.3pmol/L,患者接受了部分甲状旁腺切除术和全甲状腺切除术,将血清钙和PTH降低至2.5mmol/L和1.93pmol/L,分别。组织学显示巨大的甲状腺内囊性甲状旁腺腺瘤,这是高钙血症危机的原因。术后,患者出现严重的生化和临床低钙血症,钙浓度低至1.65mmol/L,与饥饿骨骼综合征(HBS)一致,用静脉注射高剂量葡萄糖酸钙和口服阿法骨化醇治疗,血清钙恢复缓慢.放电后,甲状旁腺功能恢复,症状学在一个多月内完全解决。
结论:我们介绍了一例异常大的甲状腺内甲状旁腺腺瘤,其临床表现与恶性肿瘤相似。此类肿瘤的识别和治疗具有挑战性,需要仔细的术前评估和术后护理以防止饥饿骨综合征的风险。
BACKGROUND: Parathyroid adenoma is the most common cause of hypercalcemia and rarely leads to a hypercalcemic crisis, which is an unusual endocrine emergency that requires timely surgical excision.
METHODS: A 67-year-old male was admitted to the ER of the Euroclinic Hospital, Athens, Greece, because of elevated calcium levels and a palpable right-sided neck mass, which were accompanied by symptoms of nausea, drowsiness, and weakness for six months that increased prior to our evaluation. A gradual creatinine elevation and decreasing mental state were observed as well. The initial laboratory investigation identified severely elevated serum calcium (3.6 mmol/L) levels consistent with a hypercalcemic crisis (HC) and parathyroid hormone PTH (47.6 pmol/L) due to primary hyperparathyroidism. Neck ultrasonography (USG) identified a large, well-shaped cystic mass in the right thyroid lobe. With a serum calcium concentration of 19.5 mg/dL and a PTH of 225.3 pmol/L, the patient underwent partial parathyroidectomy and total thyroidectomy, which decreased serum calcium and PTH to 2.5 mmol/L and 1.93 pmol/L, respectively. Histology revealed a giant intrathyroidal cystic parathyroid adenoma, which was responsible for the hypercalcemic crisis. Postoperatively, the patient developed severe biochemical and clinical hypocalcemia, with calcium concentrations as low as 1.65 mmol/L, consistent with hungry bone syndrome (HBS), which was treated with high doses of intravenous calcium gluconate and oral alfacalcidol, and a slow recovery of serum calcium. After discharge, parathyroid function recovered, and symptomatology resolved entirely in more than one month.
CONCLUSIONS: We present a case involving an exceptionally large intrathyroidal parathyroid adenoma that is characterized by clinical manifestations that mimic malignancy. The identification and treatment of such tumors is challenging and requires careful preoperative evaluation and postoperative care for the risk of hungry bone syndrome.