Green Ilan, Altman Arie
Family Medicine Department, IDF, Sheba Medical Center, Tel Hashomer.
Harefuah. 2009 Oct;148(10):708-10, 733.
Paget's disease is a chronic disease in which osteoclast mediated bone resorption precedes imperfect osteoblast mediated bone repair. Symptoms include bone pain, pathological fractures, osteoarthritis and neurological symptoms. There is evidence that genetic and viral component are involved in the etiology. Hypercalcemia is rare and when it is diagnosed, primary hyperparathyroidism should be ruled out. The authors present a patient with Paget's disease and concomitant hypercalcemia. Evaluation for hypercalcemia revealed an adenoma of the parathyroid. However, despite the removal of the adenoma, the symptoms persisted. Previous studies showed that hyperparathyroidism causes hypercalcemia in Paget's disease patients. Removal of the adenoma led to improvement in calcium and alkaline phosphatase (ALP) levels but clinical improvement is seen only in patients with high calcium level prior to the operation. This leads to the assumption that symptoms of Paget's disease are due to osteoclast hypersensitivity to parathyroid hormone (PTH) and by removing the adenoma the osteoclast activity is also reduced. In summary, the most common cause of hypercalcemia in Paget's disease patients is hyperparathyroidism and adenectomy may improve the biochemical and sometimes also the clinical symptoms of Paget's disease.
佩吉特病是一种慢性疾病，其中破骨细胞介导的骨吸收先于成骨细胞介导的不完全骨修复。症状包括骨痛、病理性骨折、骨关节炎和神经症状。有证据表明遗传和病毒因素参与其病因。高钙血症很少见，一旦诊断出来，应排除原发性甲状旁腺功能亢进。作者报告了一名患有佩吉特病并伴有高钙血症的患者。对高钙血症的评估发现了甲状旁腺腺瘤。然而，尽管切除了腺瘤，症状仍持续存在。先前的研究表明，甲状旁腺功能亢进会导致佩吉特病患者出现高钙血症。切除腺瘤可使钙和碱性磷酸酶（ALP）水平有所改善，但仅在术前血钙水平高的患者中可见临床改善。这导致人们推测，佩吉特病的症状是由于破骨细胞对甲状旁腺激素（PTH）过敏，切除腺瘤后破骨细胞活性也会降低。总之，佩吉特病患者高钙血症最常见的原因是甲状旁腺功能亢进，腺瘤切除术可能改善佩吉特病的生化指标，有时也可改善临床症状。
