Morrone Luigi Francesco, Tampoia Marilina, Pansini Nicola, Gesualdo Loreto
Sezione di Nefrologia e Dialisi, Dipartimento di Scienze Mediche, Ospedale G. Rummo di Benevento.
Ann Ital Med Int. 2004 Jul-Sep;19(3):189-92.
We present the case of a 55-year-old patient who underwent total parathyroidectomy for severe hyperparathyroidism unresponsive to medical therapy, 4 years after having started hemodialysis treatment. It was decided to perform total parathyroidectomy because at macroscopic evaluation the parathyroid glands appeared completely compromised. After surgery, the patient developed hungry bone disease, characterized by severe hypocalcemia and hypophosphatemia. After parathyroidectomy, serial measurements were made for the long-term monitoring of the calcemia, phosphatemia and the serum levels of intact parathormone and bone alkaline phosphatase, a marker of bone turnover that mainly expresses bone formation. There was initially a slight decrease in the circulating levels of bone alkaline phosphatase as the calcemia dropped dramatically, then a new increase that anticipated the subsequent calcemia increase and finally, 6 months later, a decrease to very low values. We believe that the calcemia and blood bone alkaline phosphatase could be useful for the laboratory monitoring of the hungry bone state, providing information which may be useful to avoid excessive calcium administration and the dangerous consequences such as soft-tissue calcification.
我们报告一例55岁患者的病例，该患者在开始血液透析治疗4年后，因严重甲状旁腺功能亢进且药物治疗无效而接受了甲状旁腺全切除术。决定进行甲状旁腺全切除术是因为在宏观评估中甲状旁腺似乎已完全受损。术后，患者出现了饥饿骨病，其特征为严重的低钙血症和低磷血症。甲状旁腺切除术后，进行了系列测量以长期监测血钙、血磷以及完整甲状旁腺激素和骨碱性磷酸酶的血清水平，骨碱性磷酸酶是主要表达骨形成的骨转换标志物。最初，随着血钙急剧下降，骨碱性磷酸酶的循环水平略有下降，随后出现新的升高，这早于随后的血钙升高，最终在6个月后降至非常低的值。我们认为血钙和血骨碱性磷酸酶可用于饥饿骨状态的实验室监测，提供的信息可能有助于避免过度补钙以及诸如软组织钙化等危险后果。
