原发性甲状旁腺功能亢进症28例误诊剖析  

Misdiagnosis of Primary Hyperparathyroidism:A Retrospective Analysis of 28 Cases

作　　者：丁金勇[1] 任东成 任之强[2] 庞智晖[1] 万超[1] 谭成双 张在旺[3] DING Jin-yong;REN Dong-cheng;REN Zhi-qiang;PANG Zhi-hui;WAN Chao;TAN Cheng-shuang;ZHANG Zai-wang(Department of Spinal Orthopedics,the First Affiliated Hospital of Guangzhou University of Chinese Medicine,Guangzhou 510405,China;Department of Orthopedics,Shenzhen Hospital of Chinese medicine,Shenzhen,Guangdong 518000,China;Department of Anesthesiology,980 Hospital of PLA Joint Logistics Support Forces,Shijiazhuang 050082,China)

机构地区：[1]广州中医药大学第一附属医院脊柱骨科,广州510405 [2]深圳市中医院骨科,广东深圳518000 [3]联勤保障部队第九八〇(白求恩国际和平)医院麻醉科,石家庄050082

出　　处：《临床误诊误治》2019年第2期5-9,共5页Clinical Misdiagnosis & Mistherapy

基　　金：广东省科技厅项目课题(2017ZC0137)

摘　　要：目的探讨原发性甲状旁腺功能亢进症(primary hyperparathyroidism,PTHT)误诊原因及防范措施。方法对曾误诊的28例PTHT的临床资料进行回顾性分析。结果本组误诊率66. 7%(28/42)。28例首发症状为关节疼痛6例,腰痛、全身骨痛或无力6例,全身多关节疼痛致行走障碍6例,病理性骨折4例,肾绞痛或血尿、烦渴4例,恶心、呕吐、食欲缺乏或便秘2例。就诊初期误诊为骨质疏松症9例,骨肿瘤及肾结石各4例,强直性脊柱炎及类风湿性关节炎各3例,膝关节骨性关节炎2例,胃溃疡、慢性胰腺炎及骨囊肿各1例。误诊时间1周～6年。28例中1例确诊时已出现甲状旁腺危象,经治疗无效死亡;余27例按误诊疾病治疗效果不佳,后经详细分析临床表现并行相关实验室、影像学检查确诊为PTHT,均行手术治疗,术后病情好转出院。术后1个月复查甲状旁腺激素24例正常,3例稍低于正常水平。结论 PTHT起病隐匿,临床表现复杂,对该病认识不足以及过于重视局部症状而忽视整体病情判断是其误诊主要原因。提高对该病认识,熟练掌握其临床特点和诊断线索,对疑似PTHT患者进行多学科会诊,可避免或减少PTHT误诊误治。Objective To investigate causes of misdiagnosis and preventive measures for primary hyperparathyroidism(PTHT).Methods The data of 28 patients primarily diagnosed as PTHT were retrospectively analyzed.Results The rate of misdiagnosis was 66.7%(28/42).Regarding initial symptoms,we found joint pain in 6 cases,low back pain,generalized bone pain or weakness in 6 cases,walking disorder caused by systemic polyarticular pain in 6 cases,pathological fractures in 4 cases,renal colic or hematuria,polydipsia in 4 cases,and nausea,vomiting,anorectic symptom or constipation in 2 cases.For primary diagnosis,there was misdiagnosis of osteoporosis in 9 cases,bone tumors in 4,renal calculus in 4,ankylosing spondylitis in 3,rheumatoid arthritis in 3,and knee osteoarthritis in 2,and gastric ulcer,chronic pancreatitis and bone cyst in 1,respectively.The duration of misdiagnosis was 1 week to 6 years.One patient died of parathyroidstorm shortly after clear diagnosis.The remaining patients didn't respond to their treatments until they were found ill for PTHT through detailed analysis of clinical manifestations and thorough examination including laboratory tests and images and underwent surgeries.Parathyroid hormone of 24 patients'returned to the normal range 1 month after surgery,and that of 3 cases was slightly deficient.Conclusion The main reasons lying beneath misdiagnosis is lack of comprehensive understanding of its pathology which manifested insidiously and complicatedly,and focusing on local rather than general symptoms.In addition,better understanding of the disease,mastery of its clinical characteristics and diagnostic clues,and multidisciplinary consultations are mandatory to prevent or reduce misdiagnosis and mistreatment.

关 键 词：甲状旁腺功能亢进症 误诊 骨质疏松 骨肿瘤 肾结石 

分 类 号：R582.1[医药卫生—内分泌]