Bassler T, Wong E T, Brynes R K
Department of Pathology, Los Angeles County-University, Southern California Medical Center.
Am J Clin Pathol. 1993 Dec;100(6):697-700. doi: 10.1093/ajcp/100.6.697.
The diagnosis of primary hyperparathyroidism most often results from the incidental finding of hypercalcemia. In two recent cases of osteitis fibrosa cystica (OFC), however, patients without adequate access to health care served as graphic reminders that the clinical spectrum of the disease includes bone disease, and that OFC can be the presenting manifestation of long-standing primary hyperparathyroidism. Both patients complained of bone pain and had widespread osteolytic bone lesions in addition to hypercalcemia on a multitest biochemical panel. The presumptive diagnosis of malignancy with bone involvement (metastatic cancer or multiple myeloma) led to random bone marrow trephine biopsies. Examination of the bone marrow biopsy material revealed the characteristic pathology of OFC, leading to appropriate diagnosis and surgical management of large parathyroid adenomas in both patients.
原发性甲状旁腺功能亢进症的诊断大多源于血钙过高的偶然发现。然而，在最近两例纤维囊性骨炎（OFC）病例中，因无法获得充分医疗保健服务的患者，生动地提醒人们，该疾病的临床谱包括骨病，且OFC可能是长期原发性甲状旁腺功能亢进症的首发表现。两名患者均主诉骨痛，除多项生化指标检测显示血钙过高外，还存在广泛的溶骨性骨病变。最初推测为骨转移的恶性肿瘤（转移性癌或多发性骨髓瘤），遂进行了随机骨髓穿刺活检。对骨髓活检材料的检查发现了OFC的特征性病理表现，从而对两名患者的大甲状旁腺腺瘤做出了正确诊断并进行了手术治疗。
