White J C, Brandt F B, Geelhoed G W
Department of Surgery, George Washington University Medical Center, Washington, DC 20037.
Am Surg. 1988 Aug;54(8):506-9.
Four patients developed acute arthritis following parathyroidectomy over a 3 year period in two general surgical practices. The diagnosis of pseudogout was made by clinical presentation, radiologic findings and demonstration of synovial fluid crystals exhibiting weakly positive birefringence. Rapid resolution of clinical arthritis followed joint aspiration and administration of anti-inflammatory agents in all four patients. Patients with hypercalcemia have a high incidence of calcium pyrophosphate dihydrate crystal deposition into joints. Rapid drops in serum calcium levels can cause shedding of these crystals into synovial fluid which may precipitate acute attacks of pseudogout. Because the relative hypocalcemia following parathyroidectomy provides a good stimulus for crystal shedding, it follows that hypercalcemic patients undergoing parathyroidectomy should experience a high incidence of acute pseudogout. Although this entity has been described before, its occurrence is not widely recognized in clinical practice. It is proposed that these four cases observed over a 3 year period indicate that pseudogout following parathyroidectomy occurs more commonly than previously recognized.
在两家普通外科诊所的3年时间里，有4例患者在甲状旁腺切除术后出现急性关节炎。通过临床表现、影像学检查结果以及显示滑膜液晶体呈弱阳性双折射来诊断假性痛风。所有4例患者在关节穿刺并给予抗炎药物后，临床关节炎迅速缓解。高钙血症患者关节内焦磷酸钙二水合物晶体沉积的发生率很高。血清钙水平的快速下降可导致这些晶体脱落至滑液中，这可能引发假性痛风的急性发作。由于甲状旁腺切除术后的相对低钙血症为晶体脱落提供了良好的刺激，因此接受甲状旁腺切除术的高钙血症患者急性假性痛风的发生率应该很高。尽管之前已经描述过这种情况，但其在临床实践中的发生并未得到广泛认可。有人提出，在3年时间里观察到的这4例病例表明，甲状旁腺切除术后的假性痛风比之前认为的更为常见。
