Wang Gang, Zhang Xiao-chun, Pan Bai-nian, Na Yan-qun
Department of Urology, First Hospital, Institute of Urology, Peking University, Beijing, 100034, China.
Zhonghua Yi Xue Za Zhi. 2005 Mar 9;85(9):618-20.
To investigate the diagnosis and management of primary hyperparathyroidism with urolithiasis.
The clinical data of 12 patients who were diagnosed with primary hyperparathyroidism with urolithiasis from January 1998 to June 2004 were analyzed retrospectively.
Four male and five female patients were demonstrated pathologically as parathyroid adenoma, with a mean age of 45.7 +/- 11.8 years (26 approximately 57) and a stone history of 8.3 +/- 6.4 years (0.5 approximately 22). Their serum calcium and PTH level were elevated obviously, while serum phosphate of 66% patients were lowered. The positive rate and accuracy of ultrasound, CT and (99m)TC-MIBI imaging were 67%, 100%, and 100% and 67%, 75%, 100% respectively. After resection of the parathyroid adenoma, the patients' serum calcium and PTH returned to normal. The other data of 3 cases without parathyroid adenoma. all males aged 45 approximately 54, were also investigated.
Serum calcium level above 2.96 mmol/L and PTH 3.9 or more times as normal in patients with recurrent or bilateral urolithiasis should be suspected with primary hyperparathyroidism. (99m)TC-MIBI image functions best in preoperative localization of the abnormal gland. Parathyroidectomy is the curative approach for the disease. Stones should be followed up after operation and appropriate treatment should be employed when needed.
探讨原发性甲状旁腺功能亢进症合并尿路结石的诊断与治疗。
回顾性分析1998年1月至2004年6月间12例诊断为原发性甲状旁腺功能亢进症合并尿路结石患者的临床资料。
病理证实为甲状旁腺腺瘤的患者中，男性4例，女性5例，平均年龄45.7±11.8岁（26至57岁），结石病史8.3±6.4年（0.5至22年）。他们的血清钙和甲状旁腺激素水平明显升高，而66%患者的血清磷降低。超声、CT及（99m）锝-甲氧基异丁基异腈（99m）TC-MIBI显像的阳性率及准确率分别为67%、100%、100%和67%、75%、100%。切除甲状旁腺腺瘤后，患者的血清钙和甲状旁腺激素恢复正常。另外对3例无甲状旁腺腺瘤的患者资料也进行了研究，这3例均为男性，年龄45至54岁。
复发性或双侧尿路结石患者血清钙水平高于2.96 mmol/L且甲状旁腺激素高于正常3.9倍及以上时，应怀疑原发性甲状旁腺功能亢进症。（99m）TC-MIBI显像在术前异常腺体定位方面效果最佳。甲状旁腺切除术是该病的治疗方法。术后应对结石进行随访，必要时采取适当治疗。
