Frey D P
Rheumaklinik und Institut für Physikalische Medizin, Universitätsspital Zürich, Gloriastr. 25, 8091, Zürich, Schweiz.
Z Rheumatol. 2011 Nov;70(9):740-4, 746. doi: 10.1007/s00393-011-0796-4.
Parathyroid dysfunction, leading to severe clinical symptoms and radiographic changes, has decreased over the last years due to routine laboratory checks including serum calcium levels. Thus, abnormal calcium levels are detected early in the course of the disease and the underlying cause treated accordingly. Hyperparathyroidism often leads to osteoporosis and low-trauma fractures. When evaluating secondary osteoporosis analysis of calcium, phosphate and intact parathyroid hormone levels are mandatory. Osteitis fibrosa cystica and brown tumors are less frequent findings of hyperparathyroidism. However, in patients with arthritis or bone symptoms, hyperparathyroidism has to be evaluated as a possible reason. Other manifestations of hyperparathyroidism include myopathy, tendon ruptures and unspecific symptoms of the muscles and skeleton. Gout as well as pseudogout may be associated with hyperparathyroidism. Hypoparathyroidism may cause musculoskeletal diseases mimicking ankylosing spondylitis or diffuse idiopathic skeletal hyperostosis. Myopathies are sometimes induced by hypoparathyroidism. An association between systemic lupus erythematosus and hypoparathyroidism seems to exist.
由于包括血清钙水平检测在内的常规实验室检查,近年来导致严重临床症状和影像学改变的甲状旁腺功能障碍有所减少。因此,在疾病早期就能检测到钙水平异常,并据此对潜在病因进行治疗。甲状旁腺功能亢进常导致骨质疏松和低创伤性骨折。在评估继发性骨质疏松时,必须分析钙、磷和完整甲状旁腺激素水平。纤维囊性骨炎和棕色瘤是甲状旁腺功能亢进较少见的表现。然而,对于有关节炎或骨骼症状的患者,必须评估甲状旁腺功能亢进作为可能病因的情况。甲状旁腺功能亢进的其他表现包括肌病、肌腱断裂以及肌肉和骨骼的非特异性症状。痛风以及假性痛风可能与甲状旁腺功能亢进有关。甲状旁腺功能减退可能导致类似强直性脊柱炎或弥漫性特发性骨肥厚的肌肉骨骼疾病。肌病有时由甲状旁腺功能减退引起。系统性红斑狼疮与甲状旁腺功能减退之间似乎存在关联。