Valdivielso P, López-Sánchez J, Garrido A, Sánchez-Carrillo J J
Department of Internal Medicine, Universidad de Málaga, Málaga, Spain.
J Endocrinol Invest. 2006 Jul-Aug;29(7):641-4. doi: 10.1007/BF03344164.
Primary hyperparathyroidism is rarely produced by parathyroid carcinoma. We present the case of a 63-yr-old man who was admitted due to recent onset of constipation, weakness and progressive lethargy. At physical examination, a left cervical mass was palpated. Marked hypercalcemia (serum calcium 25 mg/dl) (6.22 mmol/l) complicated by renal insuficiency (serum creatinine 4.4 mg/dl) (388 micromol/l) was found, but both were unresponsive to conventional therapy and hemofiltration. Autopsy examination showed a carcinoma of the upper left parathyroid gland, multiple foci of metastatic calficications in the vessel walls and parenchyma of both lungs and kidneys, and the myocardium, which contributed to multi-organ failure and death. In addition to describing the clinical presentation, we review the mechanism of metastatic calcifications as well as the role of renal function and hyperphosphatemia, and the basis for therapy of hypercalcemic crisis.
原发性甲状旁腺功能亢进很少由甲状旁腺癌引起。我们报告一例63岁男性患者，因近期出现便秘、乏力和进行性嗜睡入院。体格检查时，可触及左侧颈部肿块。发现有明显的高钙血症（血清钙25mg/dl）（6.22mmol/l），并伴有肾功能不全（血清肌酐4.4mg/dl）（388μmol/l），但两者对传统治疗和血液滤过均无反应。尸检显示左上甲状旁腺癌，双肺、双肾血管壁和实质以及心肌出现多处转移性钙化灶，这导致了多器官功能衰竭和死亡。除了描述临床表现外，我们还回顾了转移性钙化的机制以及肾功能和高磷血症的作用，以及高钙血症危象的治疗依据。
