Romero J B, Schreiber A, Von Hochstetter A R, Wagenhauser F J, Michel B A, Theiler R
Department of Orthopaedic Surgery, University of Zurich School of Medicine, Switzerland.
Bull Hosp Jt Dis. 1996;54(3):169-74.
The authors present a case report of a 59-year-old female suffering from hyperlipidemia who developed chronic vitamin A intoxication syndrome after ingestion of 30,000 IU retinol/daily over a period of six years. The patient's main complaints included severe headaches, morning nausea, myalgias and disability around the hip, knee, and ankle joints. Radiologically, hyperostosis of the acetabular circumference and the spine was demonstrated. Because of rapidly increasing pain, total hip replacement was performed. Histology of cross sections from the femoral head revealed destructive osteoarthritis. Since no other causative reason was found, retinol may not only be responsible for hyperostotic bone and soft tissue formations but may perhaps also account for rapid progressing of degenerative joint disease. Despite the cessation of vitamin A intake the clinical symptoms persisted due to hyperlipidemia. The enlarged number of chylomicrons and the higher fraction of very low density lipoproteins may represent a second retinyl ester pool in case of overloaded fat storing Ito-cells in the liver. Therefore, rheumatological treatment reducing risk factors such as hyperlipidemia is mandatory.
作者报告了一例59岁的高脂血症女性病例，该患者在六年内每天摄入30000国际单位视黄醇后出现慢性维生素A中毒综合征。患者的主要症状包括严重头痛、晨起恶心、肌痛以及髋关节、膝关节和踝关节周围功能障碍。影像学检查显示髋臼周围和脊柱骨质增生。由于疼痛迅速加剧，患者接受了全髋关节置换术。股骨头横截面的组织学检查显示为破坏性骨关节炎。由于未发现其他致病原因，视黄醇可能不仅是导致骨质增生和软组织形成的原因，还可能是退行性关节疾病快速进展的原因。尽管停止摄入维生素A，但由于高脂血症，临床症状仍然存在。在肝脏中脂肪储存 Ito 细胞过载的情况下，乳糜微粒数量增加和极低密度脂蛋白比例升高可能代表了第二个视黄酯池。因此，必须进行降低高脂血症等危险因素的风湿病治疗。
