三发性甲状旁腺功能亢进症的特点：7例分析

The clinical features of tertiary hyperparathyroidism in 7 cases

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。

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 bad 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 hypopbosphataemia and 6 with high alkaline phosphatase level The enlarged parathyroid glands were detected in five patients by ultrasonic or CT. Tc^99 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. Conclusions Patients 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.