Nishimura K, Nozawa M, Hara T, Sonoda T, Oka T
Department of Urology, Minoh City Hospital.
Hinyokika Kiyo. 1994 Aug;40(8):729-34.
A 41-year-old woman was referred to our hospital with complaints of general fatigue, appetite loss, nausea and vomiting. Blood examination revealed high serum calcium level (21.6 mg/dl) and high serum parathyroid hormone level. Although enlarged parathyroid glands could not be clearly detected via ultrasonography, computed tomography and scintigraphy, we diagnosed her with hypercalcemic crisis due to primary hyperparathyroidism and performed parathyroidectomy after conservative therapy. A parathyroid tumor measuring 1.9 x 1.1 x 1.0 cm, and weighing 1,100 mg was found at the upper right pole of the thyroid gland, and three thyroid tumors were found in the bilateral lobes of the thyroid gland. Histological diagnosis was adenoma of the parathyroid gland and follicular adenomas of the thyroid gland. Following removal of the parathyroid tumor, the serum calcium level rapidly dropped and the symptoms rapidly improved. Hypercalcemic crisis has a high mortality, and the only treatment is surgical removal. Therefore, in patients with hypercalcemic crisis due to primary hyperparathyroidism, surgical removal should be done immediately, unless the serum calcium level has dropped and symptoms of crisis have disappeared after conservative treatment.
一名41岁女性因全身乏力、食欲减退、恶心和呕吐被转诊至我院。血液检查显示血清钙水平升高（21.6mg/dl）及血清甲状旁腺激素水平升高。尽管通过超声、计算机断层扫描和闪烁扫描未能清晰检测到增大的甲状旁腺，但我们诊断她为原发性甲状旁腺功能亢进所致的高钙血症危象，并在保守治疗后进行了甲状旁腺切除术。在甲状腺右上极发现一个大小为1.9×1.1×1.0cm、重1100mg的甲状旁腺肿瘤，且在甲状腺双侧叶发现三个甲状腺肿瘤。组织学诊断为甲状旁腺腺瘤和甲状腺滤泡性腺瘤。切除甲状旁腺肿瘤后，血清钙水平迅速下降，症状迅速改善。高钙血症危象死亡率高，唯一的治疗方法是手术切除。因此，对于原发性甲状旁腺功能亢进所致的高钙血症危象患者，除非血清钙水平已下降且危象症状在保守治疗后消失，否则应立即进行手术切除。
