甲状旁腺瘤所致原发性甲状旁腺功能亢进6例误诊分析

Misdiagnosis analysis of 6 cases of primary hyperparathyroidism by parathyroid adenoma with complication

目的探讨甲状旁腺瘤所致原发性甲状旁腺功能亢进(primary hyperparathyroidism,PHPT)误诊原因和治疗方法。方法回顾性分析6例经病理确诊甲状旁腺瘤伴发PHPT的发病特点、诊断和治疗转归。结果6例中5例首发症状为骨关节痛,1例食道癌术后伴肌肉关节疼痛。6例中并发病理性骨折和泌尿系结石各3例,泌尿系和心血管系统症状各2例,肾功能不全病史和被诊断"不全肠梗阻"各1例,误诊率95%以上。6例患者均有甲状旁腺激素增高和骨质疏松,5例高血钙、低血磷。B超、X线片、CT、MRI和^(99m)Tc-MIBI检查对诊断均有帮助,其中MRI和^(99m)Te-MIBI检查准确率更高。经手术治疗6例的相关症状和检验异常消失或明显改善。结论甲状旁腺瘤伴发PHPT误诊率高,对于原因不明的骨质疏松、骨折等骨病伴发难以纠治的内科病症,及早行甲状旁腺B超、CT、MRI和^(99m)Tc-MIBI,以除外甲状旁腺瘤伴发PHPT,手术是治疗PHPT有效的方法。

Objectives To investigate the causes of misdiagnosis and ways of treatment of primary hyperparathyroidism （PHPT） caused by parathyroid adenoma. Methods Retrospective analysis were made of the clinical characteristics, diagnosis, and treatment outcomes of six cases of parathyroid adenoma with PHPT after pathological diagnosis. Results The primary symptom was joint pain in five of these cases, but was muscle and joint pain following radical resection of esophageal carcinoma in the other case. There was pathological fracture and urolithiasis in 3 cases, respectively. Symptoms of the urinarytract and cardiovascular system occurred in 2 cases, respectively. A history of renal insufficiency andincomplete intestinal obstruction was diagnosed in 1 case, respectively. The misdiagnosis rate was more than 95%. All the six patients had higher parathyroid hormone and osteoporosis, and five of them had high blood calcium and low blood phosphorus. B ultrasonic scanning, X-ray, CT, MRI and 99mTc-MIBI examination could facilitate diagnosis. Moreover, the accuracy of MRI and 99mTc-MIBI inspection was higher. All the abnormalities detected and related symptoms disappeared or improved significantly after parathyroidectomy. Conclusion The misdiagnosis rate of parathyroid adenoma with PHPT is high. In case of osteoporosis or fractures of an unknown cause or other bone diseases concomitant with medical conditions that are difficult to improve, examination of the parathyroid gland with B-scan ultrasonography, CT, MRI or 99mTc-MIBI may be required to rule out the possibility of parathyroid adenoma with PHPT. Surgery is an effective approach to primary parathyroid adenoma with PHPT.