以甲状旁腺危象为首发表现的甲状旁腺癌1例文献报道  

A case report of parathyroid carcinoma with parathyroid crisis as the primary clinical manifestation

作　　者：曾彦平[1,2] 闫圣涛[3] 刘小瑜 江子晴 ZENG Yanping;YAN Shengtao;LIU Xiaoyu;JIANG Ziqing(The First Clinical College,Guangzhou University of Chinese Medicine,Guangzhou 510405,Guangdong,China;Emergency Department,the First Affiliated Hospital of Guangzhou University of Chinese Medicine,Guangzhou 510405,Guangdong,China;Emergency Department,China-Japan Friendship Hospital,Beijing 100029,China;Graduate School of Peking Union Medical Collage,Beijing 100730,China)

机构地区：[1]广州中医药大学第一临床医学院,广东广州510405 [2]广州中医药大学第一附属医院急诊科,广东广州510405 [3]中日友好医院急诊科,北京100029 [4]北京协和医学院研究生院,北京100730

出　　处：《山东大学学报（医学版）》2023年第1期62-68,共7页Journal of Shandong University:Health Sciences

基　　金：市校(院)联合资助项目基础与应用基础研究项目(202201020289)。

摘　　要：目的通过1例以甲状旁腺危象为首要临床表现,病理确诊为甲状旁腺癌的诊治过程进行分析报道,以期提高临床医师对该罕见病的认识。方法收集1例首诊为甲状旁腺危象,最终确诊为甲状旁腺癌患者的临床及实验室检查资料进行总结分析,并复习相关文献,对该病的诊治思路进行归纳总结。结果患者,女,70岁,以意识障碍、严重高血钙、甲状旁腺激素(PTH)异常升高、肺部感染、肾功能不全、下肢静脉血栓为首要临床表现就诊,通过抗感染、鲑降钙素、地舒单抗、抗凝等治疗后,病情曾一度好转,随后再次出现恶化。通过二次评估,采取升级抗感染、盐酸西那卡塞片治疗高钙血症、扩容等治疗后,患者病情稳定好转,为手术治疗创造条件。最终通过术后大体病理标本,确诊为甲状旁腺癌。结论甲状腺周围结节、血钙>3.5 mmol/L,PTH大于正常值上限10倍,均提示甲状旁腺癌可能。颈部超声与^(99m)Tc-MIBI两者相结合,可提高检测率。内科保守治疗虽然可以缓解临床症状,但手术仍是治疗的关键。扩大切缘对肿瘤的清除可能获益,但目前尚无统一标准。此病复发率高,长期跟踪随访、及时治疗可能提高生存率。Objective To analyze and report the diagnosis and treatment of a case of pathologically confirmed parathyroid carcinoma with parathyroid crisis as the primary clinical manifestation,in order to improve clinicians?understanding of this rare disease.Methods Clinical and laboratory examination data of a patient initially diagnosed as parathyroid crisis and finally diagnosed as parathyroid carcinoma were collected and analyzed,and relevant literature was reviewed.Results A 70-year-old female was admitted due to disorder of consciousness,severe hypercalcemia,abnormal elevation of parathyroid hormone(PTH),pneumonia,renal insufficiency,and venous thrombosis of lower limbs.After anti-infection,salmon calcitonin,desumumab,anticoagulation,and other treatments,the patient?s condition improved for a time,but then deteriorated again.After secondary evaluation,upgraded anti-infection,sinacaser hydrochloride tablets for hypercalcemia and dilation,the patient?s condition was stabled and improved,which created conditions for surgical treatment.Parathyroid carcinoma was finally confirmed by postoperative gross pathological specimens.Conclusion Peripheral thyroid nodules,serum calcium>3.5 mmol/L,and PTH>10 times of the upper limit of normal value,suggest the possibility of parathyroid carcinoma.The combination of neck ultrasound and ^(99m)Tc-MIBI can improve the detection accuracy.Surgery is still the key to treatment,although conservative medical treatment can relieve clinical symptoms.Extended resection margin may benefit tumor clearance,but there is no unified standard at present.Due to the high recurrence rate of this disease,long-term follow-up and timely treatment may improve the survival rate.

关 键 词：甲状旁腺危象 甲状旁腺癌 高钙血症 手术治疗 

分 类 号：R736.2[医药卫生—肿瘤]