甲状旁腺危象临床诊治

Diagnosis and treatment of hyperparathyroid crisis

甲状旁腺功能亢进继发的甲状旁腺危象是临床少见但常危及生命的急重症之一。目前认为甲状旁腺腺瘤内存在微囊泡结构是导致甲状旁腺危象的病理生理基础之一。甲状旁腺危象表现为血甲状旁腺素(PTH)及Ca2+显著升高,心脏、胃肠、肾脏及中枢神经系统功能衰竭。诊治中强调尽早明确诊断、准确定位病灶,积极支持治疗、把握手术时机,术中病理检查、快速PTH监测。病情危重时,术前快速降低血钙水平、稳定生命指征,尤其在充分扩容后,果断手术是抢救的关键。

Hyperparathyroid crisis induced by hyperparathyroidism is a rare and life-threatening disease, which is most commonly due to a single parathyroid adenoma and is often associated with a characteristic microcystic histopathological pattern.The common manifestationsincluding the marked elevation in PTH and Ca2＋, reflect rapid deterioration of cardiac, gastrointestinal, renal, and central nervous function. It also reinforces the importance of preoperative definite diagnostic and accurate lesions localizing, prompt initial medical management and operative timing judgment, frozen section and quickly PTH determination in the operation highlighting the difficulties facing the endocrine surgeon in dealing with parathyroid disease. It is necessary to emphasize perioperative management in treatment of hyperparathyroid crisis. However, urgent surgmy is required after the patients are hydrated sufficiently, even if conservative therapy is not successful