Al Hassan Mohamed S, El Ansari Walid, Issa Nourelhuda, Darweesh Adham, Abdelaal Abdelrahman
Department of General Surgery, Hamad General Hospital, Doha, Qatar.
Department of Surgery, Hamad General Hospital, Doha, Qatar; College of Medicine, Qatar University, Doha, Qatar; Weill Cornell Medicine - Qatar, Doha, Qatar.
Int J Surg Case Rep. 2023 Aug;109:108560. doi: 10.1016/j.ijscr.2023.108560. Epub 2023 Jul 21.
In most cases of parathyroid adenoma (PA), it is not palpable and physical examination shows no remarkable findings. Hence diagnosis requires an index of suspicion. The current paper describes four cases of severe hypercalcemia secondary to PA.
Case 1 - 29 years old Sudanese female with history of nausea/vomiting, fatigue, loss of appetite and bone aches. She had large palpable left lower neck swelling, and high calcium and PTH. Ultrasound (US) neck and SPECT/CT scan after sestamibi injection showed left inferior PA. Case 2-73 years old Sudanese male referred with history of abdominal pain and flatulence. He had severely high calcium, elevated parathormone (PTH), and high 24-hour urine calcium. US and SPECT/CT showed a left inferior PA. Case 3-54 years old Bangladeshi male, referred with history of renal colic/urolithiasis. Laboratory results showed severely high calcium and PTH levels. US and SPECT/CT scan showed right inferior PA. Case 4-35 years old Tunisian female, 12 weeks pregnant, referred with recurrent nausea and vomiting of increasing frequency from the second week of pregnancy. Laboratory tests revealed severe hypercalcemia and high PTH. US showed two parathyroid lesions.
The patients were admitted as emergency cases and investigations diagnosed severe hypercalcemia secondary to PA. All patients underwent neck exploration and PA excision. Histology confirmed PA. The four cases were swiftly assessed and treated before progressing into the more serious hypercalcemic crisis which can lead to grave consequences, particularly in the case of the pregnant female. All patients recovered with no complications and were clinically well with normal calcium level on follow up.
Severe hypercalcemia must be swiftly and thoroughly assessed to prevent the more serious hypercalcemic crisis. Clinicians need to be suspicious of parathyroid adenoma as a probable cause. Severe hypercalcemia is often accompanied with vomiting, and in pregnant females, this could be mistaken for hyperemesis gravidarum. Excision of the parathyroid adenoma treats the condition and follow up of serum calcium and PTH confirms the favorable outcome of surgery.
在大多数甲状旁腺腺瘤（PA）病例中，腺瘤不可触及，体格检查无明显发现。因此，诊断需要怀疑指数。本文描述了4例继发于PA的严重高钙血症病例。
病例1 - 一名29岁的苏丹女性，有恶心/呕吐、疲劳、食欲不振和骨痛病史。她左颈部下侧有一个可触及的大肿块，血钙和甲状旁腺激素（PTH）水平高。颈部超声（US）和注射司他比后进行的SPECT/CT扫描显示左下PA。病例2 - 一名73岁的苏丹男性，因腹痛和肠胃胀气病史前来就诊。他血钙严重升高，甲状旁腺激素（PTH）升高，24小时尿钙升高。超声和SPECT/CT显示左下PA。病例3 - 一名54岁的孟加拉男性，因肾绞痛/尿路结石病史前来就诊。实验室结果显示血钙和PTH水平严重升高。超声和SPECT/CT扫描显示右下PA。病例4 - 一名35岁的突尼斯女性，怀孕12周，自怀孕第二周起反复出现恶心和呕吐，且频率增加。实验室检查显示严重高钙血症和高PTH。超声显示两个甲状旁腺病变。
这些患者作为急诊病例入院，检查诊断为继发于PA的严重高钙血症。所有患者均接受了颈部探查和PA切除术。组织学证实为PA。这4例患者在进展为可能导致严重后果的更严重的高钙血症危象之前迅速得到评估和治疗，尤其是对于怀孕女性。所有患者均康复，无并发症，随访时临床状况良好，血钙水平正常。
必须迅速、全面地评估严重高钙血症，以预防更严重的高钙血症危象。临床医生需要怀疑甲状旁腺腺瘤可能是病因。严重高钙血症常伴有呕吐，在怀孕女性中，这可能被误诊为妊娠剧吐。切除甲状旁腺腺瘤可治疗该病，随访血钙和PTH可证实手术的良好效果。
