以反复鼻衄为主诉的原发性甲状旁腺功能亢进症伴多发棕色瘤一例  

Repeated epistaxis caused by primary hyperparathyroidism with multiple brown tumors:One case report

作　　者：周月 董冰子 耿壮 王翔[1] 王颜刚[1] Zhou Yue;Dong Bingzi;Geng Zhuang;Wang Xiang;Wang Yangang(Department of Endocrinology,Affiliated Hospital of Qingdao University,Qingdao 266003,China)

机构地区：[1]青岛大学附属医院内分泌科,266003

出　　处：《中华内分泌代谢杂志》2019年第11期981-985,共5页Chinese Journal of Endocrinology and Metabolism

基　　金：国家自然科学基金青年科学基金项目(81600691)。

摘　　要：报道1例以反复鼻衄为主诉的原发性甲状旁腺功能亢进症(primary hyperparathyroidism,PHPT)并多发性棕色瘤的临床,影像及病理特点,结合有关文献进行回顾性分析.患者,绝经后中年女性,既往关节疼痛、骨折、肾结石病史数年,因症状缺乏特异性早期未予重视.此次以反复鼻衄为主诉就诊,检验结果示高血钙、高尿钙、低血磷、高碱性磷酸酶(alkaline phosphatase,ALP)及高甲状旁腺激素(parathytoid hormone,PTH)水平,影像学检查示全身多发性棕色瘤及广泛性骨质疏松,结合右侧甲状腺下叶后方发现异常肿块,考虑诊断为PHPT,组织病理学进一步证实病变为甲状旁腺腺瘤.因此,本例为1例甲状旁腺腺瘤引发的鼻腭部棕色瘤,压迫、破坏鼻部血管而导致反复鼻衄的罕见病例.甲状旁腺瘤切除术后,患者出现暂时性低钙血症和PTH的升高,术后5个月随访部分棕色瘤自发性消退,骨密度增加,临床症状大部缓解.To report the clinical,imaging and pathological feature of a case of primary hyperparathyroidism(PHPT)with multiple brown tumors whose complain was repeated epistaxis,and to conduct a retrospective analysis with relevant literatures.A postmenopausal middle-aged woman,with a history of joint pain,fracture,and kidney stone which were neglected due to the lack of specificity of symptoms for years,went to hospital due to repeated epistaxis.Laboratory results showed high blood calcium,hypophosphatemia,alkaline phosphatase(ALP),and parathyroid hormone(PTH)levels,as well as increased urinary calcium.Imaging examination showed systemically multiple brown tumors and extensive osteoporosis.Meanwhile an abnormal mass was found behind the right thyroid.Taking all findings into account,the diagnosis was made with PHPT,and the histopathology further confirmed that the lesion was a parathyroid adenoma.This case seems to be a rare case of multiple brown tumor caused by parathyroid adenoma,which compressed and destructed nasal blood vessels,thus induced a repeated nasal discharge.After resection of parathyroid adenoma,the patient experienced a transient hypocalcemia and PTH level elevation.After 5-month follow up,part of the brown tumors spontaneously regressed,bone density increased,and her clinical symptoms were mostly relieved.

关 键 词：原发性甲状旁腺功能亢进症 甲状旁腺腺瘤 棕色瘤 鼻衄 

分 类 号：R73[医药卫生—肿瘤]