Berland Y, Olmer M, Lebreuil G, Grisoli J
Clin Nephrol. 1982 Sep;18(3):154-8.
A 62 year-old female patient with polycystic disease and chronic renal insufficiency who had required dialysis for 3 years, presented with diffuse but predominantly lumbar bone pain associated with lassitude. Radiologic studies showed diffuse osteoporosis and destruction of the 4th lumbar vertebra. Calcium levels were normal (2.30-2.50 mmoles) with increased PTH levels (1820 microliter Eq/ml). The presence of a cervical mass suggested a diagnosis of hyperparathyroidism. A cervical exploration was performed with ablation of 4 parathyroid glands and autotransplantation of a portion of the left inferior gland into the arm. Pathological studies showed the existence of carcinoma in the right superior and inferior glands, adenoma of the left superior gland and hyperplasia of the left inferior gland. The association of hyperplasia, adenoma and carcinoma could be explained by an initial hyperplasia of the 4 glands due to renal insufficiency, with subsequent transformation of 3 into adenomas of which 2 became cancerous. The patient's status was significantly improved following surgery.
一名62岁患有多囊肾病和慢性肾功能不全且已接受3年透析治疗的女性患者，出现弥漫性但以腰部为主的骨痛并伴有倦怠。放射学检查显示弥漫性骨质疏松和第四腰椎破坏。血钙水平正常（2.30 - 2.50毫摩尔），甲状旁腺激素水平升高（1820微升当量/毫升）。颈部肿物的出现提示甲状旁腺功能亢进的诊断。进行了颈部探查，切除4个甲状旁腺，并将一部分左下甲状旁腺自体移植到手臂。病理研究显示右上和下甲状旁腺存在癌，左上甲状旁腺为腺瘤，左下甲状旁腺为增生。增生、腺瘤和癌的关联可以解释为由于肾功能不全最初4个腺体发生增生，随后其中3个转变为腺瘤，其中2个变为癌。手术后患者的状况明显改善。
