核素甲状旁腺显像协助诊断甲状旁腺危象一例并文献复习  

Radionuclide Parathyroid Imagingin Diagnosis of Parathyroid Crisis Case Report and Literature Review

作　　者：左庆瑶[1] 杨芳[2] 王志新[1] 詹雪[3] 柏楠[4] 刘宝岳[5] 邓微[1] 

机构地区：[1]北京积水潭医院内分泌科,北京100035 [2]北京积水潭医院核医学科,北京100035 [3]北京积水潭医院重症监护室,北京100035 [4]北京积水潭医院普通外科,北京100035 [5]北京积水潭医院病理科,北京100035

出　　处：《标记免疫分析与临床》2016年第5期586-589,共4页Labeled Immunoassays and Clinical Medicine

基　　金：人社部留学人员科技活动择优资助

摘　　要：目的通过分析甲状旁腺危象的诊治过程,提高该病的诊治水平。方法回顾性分析1例患者的临床资料,并结合文献进行讨论。结果患者,女,75岁,主因"股骨骨折后3年,意识障碍2周"收入院。患者3年前跌倒后右股骨骨折,19个月前诊断为甲状旁腺功能亢进症,未能明确定位。2周前患者出现反应迟钝,食欲下降。查体:嗜睡状,双侧甲状腺Ⅱ°肿大。辅助检查:血钙4.51mmol/L,肌酐129μmol/L,甲状旁腺素1993.0 pg/m L。99Tcm-MIBI甲状旁腺显像:甲状腺右侧功能亢进的甲状旁腺显像。B超在反复比对后发现甲状腺右叶内增大的甲状旁腺。治疗经过:给予补液、降钙素和持续性肾脏替代治疗。患者行手术治疗,病理诊断为非典型甲状旁腺腺瘤。术后随访20个月,患者血钙、磷正常。结论甲状旁腺显像是甲状旁腺功能亢进症的首选定位检查。顽固性高钙、肾功能不全以及病情危及生命者,应考虑血液净化。对于非典型甲状旁腺腺瘤应密切随访,警惕其潜在恶性。Objective To study the diagnosis and management of parathyroid crisis.Methods One case of parathyroid crisis was conducted with99Tcm-M IBI imaging and literatures were reviewed.Results The patient was hospitalized due to disturbance of consciousness for 2 weeks.The patient had right femoral fracture resulting from a fall 3 years ago.She was diagnosed as hyperparathyroidism 19 months ago without imaging.The patient suffered from dullness and loss of appetite 2 weeks ago.Physical examination：somnolence and goiter were found.Laboratory tests：blood calcium 4.51 mmol / L,creatinine 129μmol / L,parathyroid hormone 1993.0 pg / m L 。99Tcm-M IBI imaging ：increased uptake in the parathyroid region near right thyroid lobe.Ultrasound revealed a parathyroid lesion inside the right thyroid lobe after a careful comparison.The patient underwent surgery and the pathological diagnosis was atypical parathyroid adenoma.On the follow-up at 20 months after operation,the blood calcium and phosphorus were normal.Conclusion Radionuclide imaging is useful in diagnosis and localization of hyperparathyroidism.

关 键 词：甲状旁腺功能亢进症 危象 99Tcm-甲氧基异丁基异腈显像 异位甲状旁腺肿瘤 非典型甲状旁腺腺瘤 

分 类 号：R736.2[医药卫生—肿瘤]