慢性肾脏病伴高钙血症的甲状旁腺功能亢进：原发性还是继发性？
Hyperparathyroidism with hypercalcaemia in chronic kidney disease: primary or tertiary?
作者信息
Lunn Mitchell R, Muñoz Mendoza Jair, Pasche Lezlee J, Norton Jeffrey A, Ayco Alexander L, Chertow Glenn M
机构信息
Department of Medicine , Stanford University School of Medicine , 300 Pasteur Drive, Stanford, CA, 94305 , USA.
Department of Medicine , Stanford University School of Medicine , 300 Pasteur Drive, Stanford, CA, 94305 , USA ; Division of Nephrology, Department of Medicine , Stanford University Medical Center , 780 Welch Road, Suite 106, Palo Alto, CA, 94304 , USA.
出版信息
NDT Plus. 2010 Aug;3(4):366-71. doi: 10.1093/ndtplus/sfq077. Epub 2010 May 5.
Objective . This study aims to highlight the challenges in the diagnosis of hyperparathyroidism (HPT) in patients with advanced chronic kidney disease (CKD). Methods . In this report, we describe a middle-aged Filipino gentleman with underlying CKD who presented with intractable nausea, vomiting, severe and medically refractory hypercalcaemia and parathyroid hormone (PTH) concentrations in excess of 2400 pg/mL. The underlying pathophysiology as well as the aetiologies and current relevant literature are discussed. We also suggest an appropriate diagnostic approach to identify and promptly treat patients with CKD, HPT and hypercalcaemia. Results . Evaluation confirmed the presence of a large parathyroid adenoma; HPT and hypercalcaemia resolved rapidly following resection. Conclusion . This case report is remarkable for its severe hypercalcaemia requiring haemodialysis, large adenoma size, acute-on-chronic kidney injury and markedly elevated PTH concentration in association with primary HPT in CKD.
目的。本研究旨在强调晚期慢性肾脏病（CKD）患者甲状旁腺功能亢进症（HPT）诊断中的挑战。方法。在本报告中，我们描述了一名患有基础CKD的中年菲律宾男性，他出现顽固性恶心、呕吐、严重且药物难治性高钙血症，甲状旁腺激素（PTH）浓度超过2400 pg/mL。讨论了潜在的病理生理学、病因及当前相关文献。我们还提出了一种合适的诊断方法，以识别并及时治疗患有CKD、HPT和高钙血症的患者。结果。评估证实存在一个大的甲状旁腺腺瘤；切除术后HPT和高钙血症迅速缓解。结论。本病例报告的显著之处在于其严重高钙血症需进行血液透析、腺瘤体积大、急性慢性肾损伤以及与CKD中原发性HPT相关的PTH浓度显著升高。
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