Santori F, Bocchini S, Biagi P
Servizio Dialisi, USL n. 31, Montepulciano (Siena).
Minerva Med. 1993 Jul-Aug;84(7-8):421-5.
The authors describes a case of tertiary hyperparathyroidism (HPTH) in a uremic patient on intermittent dialysis treatment: the term refers to an adenoma with ensuing uncontrolled parathormone (PTH) secretion rate arising on the ground of hyperstimulated hypertrophied parathyroid glands. The syndrome was heralded clinically by bone pain, psychiatric disorder and biochemically by increased levels of calcium and alkaline phosphatase (AP), while parathormone (PTH), did not change from basal very high levels as commonly found in uraemic patients. As hypercalcemia in the hemodialyzed is an infrequent finding the only alternative explanation could have been hypercalcemic secondary HPTH related to hyperplastic autonomous parathyroids. For no clinical and laboratory findings as well as US findings and double scintigraphy (99mTc and 201mTl) may suggest differential diagnosis the patient underwent total parathyroidectomy which actually revealed an adenoma of the left superior parathyroid gland. Bone pain and psychiatric disturbances disappeared and now get well on chronic dialysis treatment and 1.25-OH Vit D3 supplement.
作者描述了一例接受间歇性透析治疗的尿毒症患者的三发性甲状旁腺功能亢进症（HPTH）病例：该术语指的是一种腺瘤，其随后由于甲状旁腺过度刺激肥大而导致甲状旁腺激素（PTH）分泌率不受控制。该综合征在临床上表现为骨痛、精神障碍，生化指标表现为钙和碱性磷酸酶（AP）水平升高，而甲状旁腺激素（PTH）与尿毒症患者常见的基础极高水平相比并无变化。由于血液透析患者出现高钙血症并不常见，唯一的另一种解释可能是与增生性自主性甲状旁腺相关的继发性高钙血症性HPTH。由于没有临床、实验室检查结果以及超声检查结果和双同位素扫描（99mTc和201mTl）提示鉴别诊断，患者接受了甲状旁腺全切术，术中实际发现左上甲状旁腺有一个腺瘤。骨痛和精神障碍消失，患者目前在接受慢性透析治疗和补充1,25 - OH维生素D3后情况良好。
