前上纵隔异位甲状旁腺腺瘤致原发性甲状旁腺功能亢进症一例报道

Primary hyperparathyroidism caused by an ectopic parathyroid adenoma in the anterior superior mediastinum:One case report

本文报道1例因前上纵隔异位甲状旁腺腺瘤致原发性甲状旁腺功能亢进症(primary hyperparathyroidism,PHPT)的男性患者,因肾功能异常伴全身多关节疼痛就诊。入院完善常规检查提示高脂血症、高尿酸血症、2型糖尿病并肾病、慢性肾脏病Ⅳ期、PTH升高、高钙低磷血症,临床高度怀疑甲状旁腺功能亢进,行甲状旁腺超声未见明显占位,^(18)F-FDG全身代谢显像和^(99)mTc-MIBI双时相甲状旁腺显像提示前上纵隔异位甲状旁腺伴功能亢进。患者垂体前叶功能、胰腺、内分泌相关激素均未见明显异常,排除多发性内分泌腺瘤病可能,结合患者症状和既往病史,排除三发性甲旁亢可能,诊断为前上纵隔异位甲状旁腺腺瘤致PHPT。予补液、利尿、降钙素促进尿钙排泄、唑来膦酸抑制骨吸收治疗后血钙降至正常,进一步行胸腔镜下纵隔内肿物切除术,病理确诊为甲状旁腺腺瘤,术后随访各项指标正常,未见甲状旁腺功能亢进复发。对于PHPT的诊断需要结合患者的临床表现、生化指标和影像学表现综合考虑从而进行定性定位诊断,尤其需要关注是否有异位腺瘤和多内分泌腺瘤存在的可能,减少漏诊率和复发率。

This article reported a case of a male patient with primary hyperparathyroidism(PHPT)caused by an ectopic parathyroid adenoma in the anterior superior mediastinal.Hospital routine examinations indicated hyperlipidemia,hyperuricemia,type 2 diabetes with nephropathy,chronic kidney disease in stageⅣ,elevated PTH,hypercalcemia,hypophosphatemia,clinically highly suspected hyperparathyroidism.There was no obvious abnormality of parathyroid ultrasound,while ^(18)F-FDG systemic metabolic imaging and ^(99)mTc-MIBI dual-phase parathyroid imaging suggested that an ectopic parathyroid gland in the anterior superior mediastinal which was hyperactive.Evaluations of anterior pituitary function,pancreas,and endocrine-related hormones showed no obvious abnormalities,and thus we ruled out the possibility of multiple endocrine adenomas,combined with the patient′s symptoms and previous medical history,and ruled out the possibility of tertiary hyperparathyroidism,the patient was diagnosed as PHPT caused by the anterior superior mediastinal ectopic parathyroid adenoma.To restore the blood calcium to normal,the patient was treated with intravenous rehydration,diuresis,calcitonin to promote urinary calcium excretion,and zoledronic acid to inhibit bone resorption.Further thoracoscopic mediastinal tumor resection was performed,and the diagnosis of parathyroid adenoma was confirmed by pathology.All the indicators were normal and no recurrence of hyperparathyroidism was found during the follow-up.Integration of the patient′s clinical manifestations,biochemical indicators,and imaging examinations are necessary to diagnose PHPT qualitatively and location-specifically.In particular,it is necessary to pay attention to whether there is the possibilities of ectopic adenoma and multiple endocrine adenomas,to reduce the rates of missed diagnosis and recurrence.