Bersenev G A, Ilyicheva E A, Griroryev E G
Irkutsk Scientific Centre of Surgery and Traumatology.
Irkutsk Scientific Centre of Surgery and Traumatology; Irkutsk State Medical University.
Probl Endokrinol (Mosk). 2021 Mar 14;67(2):49-56. doi: 10.14341/probl12713.
In this case report the authors inform about late diagnosis of giant adenoma of the parathyroid gland with primary hyperparathyroidism (PHPT) and the development of fibrocystic osteitis with a «brown» tumor of the upper jaw. The patient has been under the care endocrinologist with type 2 diabetes mellitus and multinodular goiter for 8 years.The last 5 years there was a clinical manifestation of PHPT, but the diagnosis was made by an oncologist after the detection of a «brown» tumor of the upper jaw. According to multispiral computed tomography and scintigraphy with 99mTc-MIBI, a focal lesion was found in the upper jaw on the right, lytic foci in the bones of the cranial vault, pelvis, lower extremities, ribs on the right, as well as a giant parathyroid adenoma on the right. According to the increased risk of the patient having a malignant neoplasm of the parathyroid gland, an extended surgical treatment of PHPT in the enblock volume was carried out with the achievement of remission of the PHPT. This clinical case illustrates a variant of the severe course of PHPT with the development of such a rare complication as fibrocystic osteitis and demonstrates the importance of timely diagnosis.
在本病例报告中，作者介绍了一例甲状旁腺巨大腺瘤伴原发性甲状旁腺功能亢进症（PHPT）的延迟诊断以及上颌骨纤维囊性骨炎伴“棕色”瘤的发生情况。该患者在内分泌科医生的照料下患有2型糖尿病和结节性甲状腺肿达8年之久。在过去5年中出现了PHPT的临床表现，但在上颌骨发现“棕色”瘤后由肿瘤学家做出诊断。根据多排螺旋计算机断层扫描和99mTc-MIBI闪烁扫描，在上颌骨右侧发现一个局灶性病变，颅顶、骨盆、下肢、右侧肋骨的骨骼中有溶骨性病灶，以及右侧一个巨大的甲状旁腺腺瘤。鉴于该患者发生甲状旁腺恶性肿瘤的风险增加，对PHPT进行了扩大的整块手术治疗，实现了PHPT的缓解。该临床病例说明了PHPT严重病程的一种变体，伴有纤维囊性骨炎这种罕见并发症的发生，并证明了及时诊断的重要性。
