2型多发性内分泌瘤2例超声诊断

Ultrasound diagnosis of type 2 multiple endocrine neoplasm: a report of 2 cases

目的探讨2型多发性内分泌瘤(MEN-2)的发病特点及超声诊断思路,以期提高MEN-2临床诊断率。方法回顾性分析于海军军医大学(第二军医大学)长征医院就诊的2例经病理确诊的MEN-2患者的临床资料,总结患者的发病特点,探讨其超声诊断过程,总结超声诊断思路。结果病例1临床表现为高血压,腹部超声检查示双侧肾上腺多发嗜铬细胞瘤,因双侧受累故引起注意,从而进一步对其他内分泌腺体进行排查发现右侧甲状腺中上交界处占位,胰腺区未见异常,超声最终诊断为甲状腺髓样癌。病例2因反复尿路结石发作多年,考虑其症状可能由甲状旁腺功能亢进引起,随后超声检查发现甲状旁腺增生及甲状腺髓样癌,因此进一步检查了胰腺、肾上腺等多个内分泌器官,最后发现肾上腺嗜铬细胞瘤。从2例患者不同的临床症状入手,配合超声影像检查与之关联的多个病变的内分泌腺体,再经病理证实从而对2例MEN-2做出精准诊断。结论MEN-2临床表现多样、诊断难度高,掌握其发病特点、临床特征及超声诊断思路有助于早期发现与诊治MEN-2这一多器官受累性疾病。

Objective To explore the pathogeneic characteristics and ideas of ultrasonic diagnosis of type 2 multiple endocrine neoplasm(MEN-2),so as to improve the clinical diagnosis rate.Methods The clinical data of 2 patients with pathologically confirmed MEN-2 in Changzheng Hospital of Naval Medical University(Second Military Medical University)were retrospectively analyzed.The pathogenic characteristics of 2 patients were summarized.The process of ultrasound diagnosis was discussed,and the ideas of ultrasound diagnosis was summarized.Results Patient 1 presented with hypertension.Abdominal ultrasonography showed multiple pheochromocytomas in the bilateral adrenal glands,which attracted attention because of bilateral involvement.Further examination of other endocrine glands revealed that the right upper and middle thyroid junction had an occupation,and there was no abnormality in the pancreas.Ultrasound finally diagnosed medullary thyroid carcinoma.Patient 2 had recurrent urinary calculi for many years.Considering its symptoms might be caused by hyperparathyroidism,we performed ultrasonography and found hyperplasia of parathyroid gland and medullary thyroid cancer.Therefore,we further examined several endocrine organs such as pancreas and adrenal gland,and finally found pheochromocytoma of adrenal gland.Based on the different clinical symptoms of the 2 patients,we made accurate diagnoses through ultrasound examination of endocrine glands associated with multiple lesions combined with pathological results.Conclusion MEN-2 has a variety of clinical manifestations and is difficult to diagnose.It is helpful for early diagnosis of MEN-2,a multi-organ involvement disease,by mastering its pathogenic characteristics,clinical characteristics and ultrasound diagnosis ideas.