Huang J J, Sung J M, Wu T J, Ruaan M K, Huang S M, Chow N H
Department of Internal Medicine Surgery, National Cheng Kung University Hospital, Tainan, Taiwan, R.O.C.
J Formos Med Assoc. 1992 Sep;91 Suppl 3:S255-9.
Parathyroid storm in patients with primary hyperparathyroidism has previously been described as hyperparathyroid crisis, parathyroid intoxication or acute hyperparathyroidism. Whatever the nomenclature, all emphasize the severity and urgency of this disease entity. Although fewer than 200 cases have been described since the first report by Dawson in 1932, it is generally agreed that parathyroid storm is more prevalent than commonly appreciated. The symptoms and signs of the syndrome are not only due to the hypercalcemia, but also to the toxic effects of the parathyroid hormone (PTH). Its wide, but nonspecific clinical presentations make it easily confused with other cardiovascular or renal diseases. The mortality rate in untreated cases of parathyroid storm is essentially 100%. With combined medical-surgical treatment, it is still reported to be as high as 40%. Two patients with parathyroid storm were encountered at our institute recently, they both presented with severe hypercalcemia, consciousness disturbance and acute renal failure. The serum level of the intact form of PTH (iPTH) in both patients was greater than 1,000 pg/mL. Case 1, a 63-year-old female, presented with hypercalcemic crisis. Initially, good responsiveness to a saline infusion, steroids and furosemide administration was noted. Unfortunately, she became comatous after fine-needle aspiration of the parathyroid tumor. The recurrent storm was refractory to medical therapy, but was treated successfully by surgical removal of the single adenoma. This is a rare reported case regarding a hyperparathyroid storm after fine-needle aspiration of a parathyroid adenoma.(ABSTRACT TRUNCATED AT 250 WORDS)
原发性甲状旁腺功能亢进患者的甲状旁腺危象以前被描述为甲状旁腺危象、甲状旁腺中毒或急性甲状旁腺功能亢进。无论采用何种命名，都强调了这种疾病实体的严重性和紧迫性。自1932年道森首次报告以来，虽然描述的病例不到200例，但人们普遍认为甲状旁腺危象比通常认为的更为普遍。该综合征的症状和体征不仅归因于高钙血症，还归因于甲状旁腺激素（PTH）的毒性作用。其广泛但非特异性的临床表现使其容易与其他心血管或肾脏疾病混淆。未经治疗的甲状旁腺危象患者的死亡率基本上为100%。据报道，采用内科-外科联合治疗时，死亡率仍高达40%。最近在我们研究所遇到了两名甲状旁腺危象患者，他们都表现为严重高钙血症、意识障碍和急性肾衰竭。两名患者的完整甲状旁腺激素（iPTH）血清水平均大于1000 pg/mL。病例1是一名63岁女性，表现为高钙血症危象。最初，观察到对生理盐水输注、类固醇和呋塞米给药反应良好。不幸的是，她在甲状旁腺肿瘤细针穿刺后昏迷。复发性危象对药物治疗无效，但通过手术切除单个腺瘤成功治愈。这是一例关于甲状旁腺腺瘤细针穿刺后发生甲状旁腺危象的罕见报道病例。（摘要截短于250字）
