背景:在大多数甲状旁腺腺瘤(PA)病例中,无法触及,体格检查没有显着发现。因此,诊断需要怀疑的指标。本文描述了4例PA继发的严重高钙血症。
方法:病例1-29岁有恶心/呕吐病史的苏丹女性,疲劳,食欲不振和骨痛。她有明显的左下颈肿胀,和高钙和PTH。超声(US)颈部和SPECT/CT扫描显示左下PA。病例2-73岁苏丹男性,有腹痛和胀气病史。他有严重的高钙,甲状旁腺激素(PTH)升高,和高24小时尿钙。US和SPECT/CT显示左下PA。案例3-54岁孟加拉男性,有肾绞痛/尿石症病史。实验室结果显示严重高的钙和PTH水平。US和SPECT/CT扫描显示右侧下PA。案例4-35岁突尼斯女性,怀孕12周,从怀孕第二周开始,反复出现恶心和呕吐。实验室检查显示严重的高钙血症和高PTH。US显示两个甲状旁腺病变。
结论:患者作为急诊病例入院,调查诊断为PA继发的严重高钙血症。所有患者均行颈部探查和PA切除术。组织学证实PA。在进展为可能导致严重后果的更严重的高钙血症危机之前,对这四个病例进行了迅速评估和治疗。特别是在怀孕的女性的情况下。所有患者均恢复,无并发症,临床良好,随访钙水平正常。
结论:必须迅速彻底地评估严重的高钙血症,以预防更严重的高钙血症危象。临床医生需要怀疑甲状旁腺腺瘤是可能的原因。严重的高钙血症常伴有呕吐,在怀孕的女性中,这可能会被误认为是妊娠剧吐。切除甲状旁腺腺瘤可治疗病情,并对血清钙和PTH进行随访,证实手术效果良好。
BACKGROUND: In most cases of parathyroid adenoma (PA), it is not palpable and physical examination shows no remarkable findings. Hence diagnosis requires an index of suspicion. The current paper describes four cases of severe hypercalcemia secondary to PA.
METHODS: Case 1 - 29 years old Sudanese female with history of nausea/vomiting, fatigue, loss of appetite and bone aches. She had large palpable left lower neck swelling, and high calcium and PTH. Ultrasound (US) neck and SPECT/CT scan after sestamibi injection showed left inferior PA. Case 2-73 years old Sudanese male referred with history of abdominal pain and flatulence. He had severely high calcium, elevated parathormone (PTH), and high 24-hour urine calcium. US and SPECT/CT showed a left inferior PA. Case 3-54 years old Bangladeshi male, referred with history of renal colic/urolithiasis. Laboratory results showed severely high calcium and PTH levels. US and SPECT/CT scan showed right inferior PA. Case 4-35 years old Tunisian female, 12 weeks pregnant, referred with recurrent nausea and vomiting of increasing frequency from the second week of pregnancy. Laboratory tests revealed severe hypercalcemia and high PTH. US showed two parathyroid lesions.
CONCLUSIONS: The patients were admitted as emergency cases and investigations diagnosed severe hypercalcemia secondary to PA. All patients underwent neck exploration and PA excision. Histology confirmed PA. The four cases were swiftly assessed and treated before progressing into the more serious hypercalcemic crisis which can lead to grave consequences, particularly in the case of the pregnant female. All patients recovered with no complications and were clinically well with normal calcium level on follow up.
CONCLUSIONS: Severe hypercalcemia must be swiftly and thoroughly assessed to prevent the more serious hypercalcemic crisis. Clinicians need to be suspicious of parathyroid adenoma as a probable cause. Severe hypercalcemia is often accompanied with vomiting, and in pregnant females, this could be mistaken for hyperemesis gravidarum. Excision of the parathyroid adenoma treats the condition and follow up of serum calcium and PTH confirms the favorable outcome of surgery.