Keynes W M, Caird F I
Br Med J. 1970 Jan 24;1(5690):208-11. doi: 10.1136/bmj.1.5690.208.
A patient with many symptoms and signs of primary hyperparathyroidism had hypocalcaemia when first seen. Bone section histology showed osteomalacia and osteitis fibrosa, and the hyperparathyroidism at this stage was considered to be secondary to osteomalacia with postgastrectomy steatorrhoea. On treatment with vitamin D (with disappearance of her bone pains and weakness) she developed hypercalcaemia. She regained her health after removal of a 6-g. parathyroid adenoma. Normal histology was shown in another parathyroid gland.We believe that the initial hypocalcaemia was due to vitamin-D deficiency, which produced ineffective hyperparathyroidism until it was corrected. A review of the few reports of patients with autonomous hyperparathyroidism with steatorrhoea and osteomalacia does not support the argument that these patients had "tertiary" disease. It suggests that most of them, like our patient, had primary hyperparathyroidism.
一名有许多原发性甲状旁腺功能亢进症状和体征的患者初诊时存在低钙血症。骨切片组织学显示有骨软化症和纤维性骨炎，此时的甲状旁腺功能亢进被认为继发于胃切除术后脂肪泻所致的骨软化症。在用维生素D治疗（她的骨痛和乏力消失）后，她出现了高钙血症。切除一个6克的甲状旁腺腺瘤后她恢复了健康。另一个甲状旁腺显示组织学正常。我们认为最初的低钙血症是由于维生素D缺乏，在其得到纠正之前导致了无效的甲状旁腺功能亢进。对少数患有自主性甲状旁腺功能亢进伴脂肪泻和骨软化症患者的报告进行回顾，并不支持这些患者患有“三期”疾病的观点。这表明他们中的大多数，像我们的患者一样，患有原发性甲状旁腺功能亢进。
