骨质疏松持续补钙导致高钙危象1例及文献复习

A Case Study of Osteoporosis with Continuous Calcium Supplementation Leading to Hypercalcemia Crisis and Review of the Literatures

目的分析1例86岁女性患者高钙危象的实验室检验结果,分析高钙血症的病因,进一步为临床诊断提供参考依据。方法分析1例86岁高钙危象患者在疾病初期的实验室检查结果,以及停用钙剂2月后实验室检查结果,比较两次结果的变化,并分析变化产生的原因,助力临床对患者高钙血症病因的鉴别诊断。结果该患者首诊时因长期服用钙剂抑制了甲状旁腺素(parathyroid hormone,PTH)的分泌,PTH处于正常水平,停用钙剂后PTH异常升高。该患者最终诊断为原发性甲状旁腺功能亢进症(primary hyperparathyroidism,PHPT)。结论该患者高钙危象的原因为,在PHPT基础上,大剂量补充碳酸钙和骨化三醇,加重了高钙血症,产生呕吐症状,呕吐进一步加重血钙升高。

Objective To analyze the laboratory test results of an 86-year-old female patient with hypercalcemic crisis,analyze the etiology of hypercalcemia,and to further provide a reference basis for the clinical diagnosis.Methods We analyzed the laboratory test results of an 86-year-old patient with hypercalcemia in the early stage of the disease and the laboratory test results after 2 months of calcium withdrawal.We then compared the changes in the two results and identified the reasons for the changes,leading to a better clinical diagnosis of the cause of hypercalcemia.Results At the time of the first visit,the patient’s parathyroid hormone(PTH)was at normal level due to long-term calcium suppression of PTH secretion,and PTH increased abnormally after calcium withdrawal.The patient was then diagnosed with Primary Hyperparathyroidism(PHPT).Conclusion The cause of hypercalcemia in this patient is high-dose supplementation of calcium carbonate and osteotriol on top of PHPT,which aggravates hypercalcemia and produces vomiting symptoms,and vomiting further aggravates the elevated blood calcium.