Papageorgiou Sokratis G, Christou Yolanda, Kontaxis Theodoros, Bonakis Anastasios, Anagnostouli Maria, Potagas Constantinos, Kalfakis Nikolaos
Department of Neurology, Athens University Medical School, Eginition Hospital, Athens, Greece.
Clin Neurol Neurosurg. 2008 Dec;110(10):1038-40. doi: 10.1016/j.clineuro.2008.06.004. Epub 2008 Jul 26.
The case of a 76-year-old female patient is presented with a two-year history of progressive dementia, apathy and gait impairment. Initially, Alzheimer's disease was diagnosed and she was given donepezil for one year with no significant improvement. An extensive blood and biochemical control revealed high serum calcium and parathormone levels, and normal thyroid hormones and anti-thyroid antibodies. Ultrasound of thyroid and parathyroid glands revealed an adenoma of the right parathyroid. The detailed investigation for causes of secondary hyperparathyroidism was negative. Due to the absence of clinical hyperparathyroidism she was initially treated conservatively. At referral, the neurological picture consisted of: mild signs of parkinsonism, moderate dementia (MMSE=15) and severe behavioural disturbances. Because of the continuous aggravation of the cognitive deficit, parathyroidectomy was decided although there were no clinical or laboratory signs of involvement from other organs. Three weeks after the operation the neurological picture showed dramatical improvement. Parkinsonism and behavioural disorders were remarkably reduced and the MMSE score raised to 25. In summary we report an exceptional case of primary hyperparathyroidism (PHPT) presenting as dementia and treated successfully by parathyroidectomy.
本文介绍了一位76岁女性患者的病例，她有两年进行性痴呆、淡漠和步态障碍的病史。最初被诊断为阿尔茨海默病，并给予多奈哌齐治疗一年，但无明显改善。全面的血液和生化检查显示血清钙和甲状旁腺激素水平升高，甲状腺激素和抗甲状腺抗体正常。甲状腺和甲状旁腺超声检查发现右甲状旁腺腺瘤。继发性甲状旁腺功能亢进病因的详细检查结果为阴性。由于没有临床甲状旁腺功能亢进表现，她最初接受保守治疗。转诊时，神经系统表现为：轻度帕金森症体征、中度痴呆（简易精神状态检查表[MMSE]=15）和严重行为障碍。尽管没有其他器官受累的临床或实验室迹象，但由于认知缺陷持续加重，决定进行甲状旁腺切除术。术后三周，神经系统表现显著改善。帕金森症和行为障碍明显减轻，MMSE评分提高到25。总之，我们报告了一例以痴呆为表现的原发性甲状旁腺功能亢进（PHPT）特殊病例，并通过甲状旁腺切除术成功治疗。
