Dusilová Sulková Sylvie, Horáček Jiří, Vykoukalová Eva, Šafránek Roman, Malá Alena, Palička Vladimír
Academic Department of Internal Medicine, Charles University, Faculty of Medicine in Hradec Králové, Czech Republic.
Haemodialysis Centre, University Hospital Hradec Králové, Czech Republic.
Acta Medica (Hradec Kralove). 2017;60(2):85-88. doi: 10.14712/18059694.2017.99.
We present a case of severe calciphylaxis in both thighs and calves in a patient with end-stage renal disease and advanced secondary hyperparathyroidism with successful outcome after modified therapeutic approach. The cause of calciphylaxis is multifactorial. In our case, not only severe hyperparathyroidism and mediocalcinosis, but also medication (warfarin, calcium and active vitamin D) was involved. Because the initial conservative therapy was not successful, we indicated parathyroidectomy. However, we were not able to localize parathyroid glands and we contraindicated bilateral neck exploration due to the patient's critical status. Therefore, we decided for total thyroidectomy with total parathyroidectomy. Surgery was uncomplicated and histology confirmed that all four parathyroid glands were removed. The expected post-operative hypocalcaemia was asymptomatic and we did not use any calcium supplementation or vitamin D. Thyroid hormone replacement was easy. After surgery, the large and multiple subcutaneous defects started to heal. We achieved complete healing within several months of continuing dedicated care. There is no recurrence after three years. Prompt and radical surgical parathyroidectomy was extremely useful in our patient.
我们报告了一例患有终末期肾病和晚期继发性甲状旁腺功能亢进的患者，其双大腿和小腿出现严重钙化防御，经改良治疗方法后取得成功。钙化防御的病因是多因素的。在我们的病例中，不仅有严重的甲状旁腺功能亢进和血管中层钙化，还涉及药物（华法林、钙和活性维生素D）。由于初始保守治疗未成功，我们建议进行甲状旁腺切除术。然而，我们无法定位甲状旁腺，且由于患者病情危急，我们不建议进行双侧颈部探查。因此，我们决定进行全甲状腺切除术加全甲状旁腺切除术。手术过程顺利，组织学检查证实所有四个甲状旁腺均被切除。预期的术后低钙血症无症状，我们未使用任何补钙或维生素D。甲状腺激素替代治疗很简单。手术后，大面积的多处皮下缺损开始愈合。经过数月持续的精心护理，我们实现了完全愈合。三年后无复发。及时而彻底的手术甲状旁腺切除术对我们的患者极为有用。
