Szewczyk L, Kołłataj W
Klinika Pediatrii, Endokrynologii i Chorób Młodziezy Akademii Medycznej w Lublinie.
Przegl Lek. 2000;57(2):133-4.
Primary hyperparathyroidism caused by solitary adenomas occurs rarely (especially in children and adolescents). The clinical manifestations are usually subtle and that is why the mentioned disorder is usually late diagnosed and as an effect--late treated. We present the case of a 17 year old girl, an ambulatory patient who had been "observed" for over 12 months because of persistent ostealgia. She had not been properly diagnosed. The first diagnostic investigation of calcium and phosphate balance was provided only when multifocal osteolysis of tibias, hip and metacarpal bones was detected and biopsy of the mentioned osteolytic lesions was done. After the admission to The Department of Pediatrics, Endocrinology and Disease of Adolescents: Ca 3.02-3.06 mmol/l, PO4- 0.32-0.62 mmol/l, ACP 19.4 U/l, ALP 864 U/l, PTH 770 pg/ml [normal values: 10-70]. Densitometry findings: BMD (Neck[L]) 0.636 g/cm2, BMD (Neck[R]) 0.722 g/cm2. The parathyroid adenoma was removed after the exploration and localization with MIBI99mTc (scintigraphy). Clinical diagnosis was verified by histologic findings. 5 months after: BMD (Neck[L]) 0.850 g/cm2, BMD (Neck[R]) 0.741 g/cm2, calcemia 2.38 mmol/l, phosphatemia 1.14 mmol/l, ACP 6.2 U/l, ALP 159 U/l. Radiograms show evident improvement of bone tissue structure.
由孤立性腺瘤引起的原发性甲状旁腺功能亢进很少见（尤其是在儿童和青少年中）。其临床表现通常不明显，这就是上述疾病通常诊断较晚且因此治疗也晚的原因。我们报告一例17岁女孩的病例，该门诊患者因持续骨痛“观察”了12个月以上。她未得到正确诊断。仅在检测到胫骨、髋骨和掌骨的多灶性骨质溶解并对上述溶骨性病变进行活检后，才首次进行钙磷平衡的诊断性检查。入住儿科、内分泌与青少年疾病科后：血钙3.02 - 3.06 mmol/l，血磷0.32 - 0.62 mmol/l，酸性磷酸酶19.4 U/l，碱性磷酸酶864 U/l，甲状旁腺激素770 pg/ml [正常值：10 - 70]。骨密度测定结果：左侧颈部骨密度0.636 g/cm²，右侧颈部骨密度0.722 g/cm²。经99mTc - MIBI（闪烁扫描）探查和定位后切除甲状旁腺腺瘤。组织学检查结果证实了临床诊断。5个月后：左侧颈部骨密度0.850 g/cm²，右侧颈部骨密度0.741 g/cm²，血钙2.38 mmol/l，血磷1.14 mmol/l，酸性磷酸酶6.2 U/l，碱性磷酸酶159 U/l。X线片显示骨组织结构明显改善。
