原发性甲状旁腺机能亢进症引起的全身多发性骨吸收

Multiple bone resorptions in primary hyperparathyroidism

目的早期诊断和治疗原发性甲状旁腺机能亢进症引起的多发性骨吸收。方法回顾性分析1997年4月～2001年4月以多发性骨病变收入院的4例和外院会诊的1例原发性甲状旁腺机能亢进症患者的临床资料,其中男1例,女4例;年龄25～46岁,平均37岁。从发病至确诊的时间最长36个月,最短8个月,平均19.5个月。1例患者曾在当地医院行骨病变活检术,但未能早期确诊。所有患者疼痛均较严重,需服用强效止痛药物。大部分患者都有乏力、精神不振、食欲低下、胃肠不适等症状。同位素骨扫描显示全身骨骼多发核素异常浓聚区,X线片显示多发的颅骨、肋骨、骨盆及四肢骨吸收。实验室检查:血钙2.27～3.22mmol/L,甲状旁腺素168～214ng/ml。3例患者颈部能触及肿块,2例触诊正常。所有患者均转入普通外科。结果甲状旁腺切除术后病理确诊为原发性甲状旁腺机能亢进症,其中甲状旁腺腺瘤3例,甲状旁腺组织增生2例。甲状旁腺切除术后患者的全身疼痛均减轻。随访3～27个月,平均15个月。随访时患者原有骨吸收区域都有不同程度的钙化和缩小。结论在临床上,对于以全身多发骨病变就诊于骨科的较年轻患者,应考虑原发性甲状旁腺机能亢进性骨病的可能。确诊后,应及时切除异常甲状旁腺,避免骨吸收的进一步加重。

Objective To discuss the importance of early di agnosis and treatment of primary hy-perparathyroidism in multiple bone resorptions.Methods From April 1997to April 2001,5patie nts were regarded as having multiple bone resorptions.There were 4females and 1male.The age ranged from 25to 46years(average 37years).The mean interval between symptom o nset and final diagnosis was 19.5mon ths(from8to 36months).All patients were suffering from se vere bone pain in need of strong antalgic,and the symptoms including fatigue,depression,loss of appetite and malaise,e tc.Abnormality on bone scan indicated multiple areas of skeletal involvem ent,bone radiographs showed multip le bone resorptions in skull,rib,pelvis and limbs.The range of serum calcium level was 2.27-3.22mmol /L and that o f PTH was 168-214ng /ml.Palpable neck mass was found i n three patients.Results All patients had undergone resectio n of the abnormal parathyroid.Three were parathyroid adenomas and two defined a s hyperplastic glands.All of them had pain relief after operation.The average follow-up was 15months(3-27months);the bone lesions have been repaired partially or totally s hown in X -ray examination during follow-up.Conclusion Clinically,in younger patients with multiple bone resorptions,hyperparathyroidism should be highly suspected,so that timely parathyroid surgery can be ca rried out for the treatment.[