甲状旁腺功能亢进症致多发棕色瘤诊治经验探讨

骨质疏松患者合并高血钙、低血磷时应注意鉴别甲状旁腺功能亢进症,当甲状旁腺功能亢进症合并骨破坏病例应警惕棕色瘤,棕色瘤临床上易与骨转移瘤、骨巨细胞瘤混淆。棕色瘤早期以保守治疗为主,后期可考虑手术治疗,不能手术患者建议双膦酸盐治疗,但尚需更多证据支持。     

Multiple brown tumors with primary hyperparathyroidism mimicking bone metastases []

Multiple osteolytic lesions are usually associated with bone metastasis. However, brown tumor should also be included in the differential diagnosis. Brown tumor is a rare benign lesions in skeletal system, encountered in patients with uncontrolled primary or secondary hyperparathyroidism. In our case report, we present a 35-year-old female with multifocal brown tumor that difficultiy in differential diagnosis of metastasis of malignant parathyroid. Additionally, the treatment and follow up after parathyroidectomy are also emphasized.MethodsThe SCARE 2020 Guideline [1].     

关注甲状旁腺功能增强和正常血钙型原发性甲状旁腺功能亢进症的防治

随着血钙及甲状旁腺素（PTH）等各种实验室检查技术的发展,大量无症状或正常血钙型原发性甲状旁腺功能亢进症（primary hyperparathyroidism,PHPT）得以早期诊断。PHPT已成为影响人类健康的第三大常见内分泌系统疾病。目前部分PHPT,尤其是多数正常血钙型PHPT,并非原发,可能是长期钙摄入不足和...     

Paraplegia caused by brown tumor in primary hyperparathyroidism. Case report

A brown tumor is a secondary disorder of bone associated with hyperparathyroidism that arises predominantly in the metacarpals, phalanges, jaw, pelvis, or femur. Rarely does this tumor involve the spine. The authors describe a case of brown tumor in primary hyperparathyroidism, causing spinal cord compression. The first step in diagnosing this lesion in an unusual site is a high index of suspicion. Essentially, this tumor is benign but emergency surgery for tumor removal is recommended in patients showing acute spinal cord compression.     

Detection of parathyroid adenoma in patients with primary hyperparathyroidism: the use of office-based ultrasound in preoperative localization

BACKGROUND: The purpose of this investigation is to show that preoperative localization of the parathyroid gland using office-based ultrasound (US) and Tc-99m sestamibi scan is superior to all other approaches in detecting a parathyroid adenoma. METHODS: We performed a retrospective analysis of 43 patients who underwent parathyroidectomy for primary hyperparathyroidism. All patients underwent office-based US and sestamibi scintigraphy. Upon completion of the localization studies, a plan for focused or full operation was determined. RESULTS: In 42 of 43 patients, office-based US performed by a surgeon and sestamibi scintigraphy successfully detected the location of a parathyroid abnormality (42/43 cases, sensitivity = 98%, P < .05 =.0001). Office-based US localized the abnormal gland to the specific side (right/left) in 36 of 43 cases (84%). Sestamibi alone localized to the specific side in 29 of 43 cases (67%) for a statistically significant difference (P = .03). US localized the abnormal gland to the specific quadrant (34/43 cases [79%] sensitivity versus 23/43 cases [53%] sensitivity using sestamibi scan alone to localize to the specific quadrant, P = .03). CONCLUSION: It is clear that the combined modalities of office-based US and sestamibi scintigraphy in preoperative localization have a high success rate and should be considered in parathyroid surgery.     

Pasieka Illness Questionnaire: its value in primary hyperparathyroidism

Background: A prospective study was undertaken to assess the Pasieka Illness Questionnaire (PIQ) as a clinical evaluation and outcome tool in an Australian setting. The PIQ was specifically designed to assess the impact of surgery on the preoperative symptoms of patients with primary hyperparathyroidism (1° HPT). Methods: Sixty of 71 consecutive patients referred with 1° HPT completed the PIQ preoperatively and 3 months after parathyroid surgery. Fifty‐four of the 60 patients filled in a 12‐month follow‐up questionnaire that included a quality of life (QOL) and a self‐rated health uni‐scale. Serum calcium, ionized calcium and parathyroid hormone levels were obtained on each occasion Results: Eighty per cent of patients identified a significant decrease in symptoms following surgery. QOL and self‐rated health improved after undergoing parathyroid surgery. Serum calcium levels returned to normal in 97% of patients 12 months after surgery. Conclusions: The present study supports the use of the Pasieka Illness Questionnaire as a useful method to measure disease‐specific symptoms in patients with 1° HPT and is applicable to Australian patients. It also shows, once again, that parathyroid surgery produces a significant improvement in the preoperative symptoms of 1° HPT.     

Sigmoid colon cancer associated with primary hyperparathyroidism: Report of a case

(Received for publication on Apr. 13, 1998; accepted on Jan. 7, 1999)     

肾结石合并原发性甲状旁腺功能亢进的诊治体会

目的探讨反复双肾结石患者中原发性甲状旁腺机能亢进的诊断和治疗,提高对本病的认识。方法回顾性分析2009年2月～2011年3月因反复双肾结石就诊,临床诊断原发甲旁亢5例的资料。结果 5例病理证实为甲状旁腺腺瘤,男2例,女3例,年龄18～56岁,平均年龄（35.6±9.6）岁,结石病史0.5～3.0年,平均时间（2.4±0.3）年。血钙和甲状旁腺激素明显升高,血磷降低。切除腺瘤后,患者血钙、血磷和甲状旁腺激素恢复正常。结论手术是治疗原发甲旁亢的有效方法。甲状旁腺手术可以明显降低结石复发,甲旁亢的早期诊治有益于减少结石复发和保护肾功能。术后应密切随访尿路结石,必要时予相应治疗。     

Selective unilateral parathyroid exploration: an effective treatment for primary hyperparathyroidism

Background

Unilateral neck exploration (UNE) is a well-recognized approach in the treatment of primary hyperparathyroidism (PHP). The objective of this study was to review the success of an approach involving UNE guided by preoperative sestamibi (SM) scanning.

Methods

All data were gathered by retrospective chart review. All patients undergoing surgery for the treatment of primary hyperparathyroidism at a tertiary referral center over a 3-year period were included in the study cohort.

Results

Fifty-two of 80 patients (65%) had an SM scan consistent with a solitary adenoma and were eligible for a UNE, with 57.5% (46/80) undergoing a UNE. Seventy-seven of 80 (96.3%) patients were normocalcemic after initial neck exploration. UNE was curative in 50 of 52 (96.2%) UNE eligible patients and required less operative time than bilateral neck exploration (mean, 60 versus 87 minutes).

Conclusion

Selective unilateral neck exploration, guided by preoperative SM scanning, is an effective surgical approach for the management of primary hyperparathyroidism.     

Clinical and laboratory characteristics of calcium stone-formers with and without primary hyperparathyroidism

OBJECTIVE

To compare the clinical presentation, laboratory features and outcome of treatment in stone formers (SF) with primary hyperparathyroidism (HPT) to those without systemic disease.

PATIENTS, SUBJECTS AND METHODS

We compared 105 (54 female) stone‐formers (SF) with primary hyperparathyroidism (HPT) to 2416 (835 female) common SF with no systemic disease, and 260 normal subjects (NS, 106 female) using pre‐treatment and treatment data from our kidney‐stone programme. All were assessed before treatment, with three 24‐h urine samples, for stone risk factors, each with a corresponding fasting blood sample. Records were reviewed for stone rates and urological stone‐related procedures.

RESULTS

The hypercalcaemia of HPT was modest, but hypercalciuria was far more marked than in SF because the fractional calcium excretion of HPT exceeded that of SF. Surgical cure of HPT did not completely eradicate either hypercalciuria or hypophosphataemia, suggesting that these patients have some additional mineral disorder. Serum calcium and phosphate, and fractional excretion of calcium, combined into a discriminant function provided the best separation between HPT and SF. However, we present 49 patients for whom the diagnosis (HPT vs SF) has never been resolved, despite years of observation and successful reduction of stone recurrence. Stones in HPT have slightly more phosphate than SF but the difference is not large enough to be of clinical interest. The stone frequency in HPT is about that for SF, and treatment reduces stones in HPT and SF by about the same amount, 10 times.

CONCLUSION

No study to date has compared HPT with SF and NS, as done here. SF with even slight hypercalcaemia and brisk hypercalciuria probably have this curable disease, and after cure clinicians must be wary of residual hypercalciuria that requires medical treatment. Some patients will never be fully diagnosed and remain, like ours, an enigma, albeit responsive to usual medical treatments. Although stones are modestly enriched with phosphate, most are mainly calcium oxalate, so the stone analysis is not clinically a guide to diagnosis.     

De novo expression of transforming growth factor-{alpha} in parathyroid gland tissue of patients with primary or secondary uraemic hyperparathyroidism

BACKGROUND.: The factors involved in abnormal parathyroid cell secretoryfunction and growth in patients with primary and secondary hyperparathyroidismare still incompletely understood. PATIENTS AND METHODS.: We studied the expression of transforming growth factor- (TGF-),epidermal growth factor (EGF) and EGF receptor (EGF-R) at thegene message and the protein level in parathyroid tissue obtainedfrom six patients with primary hyperparathyroidism, 15 patientswith secondary uraemic hyperparathyroidism and five subjectswith normal parathyroid tissue, using in situ hybridizationand/or immunostaining technique. RESULTS.: We found a consistent expression of TGF- mRNA and protein inparathyroid endocrine cells of all six cases of primary parathyroidadenoma and in nearly all cases of secondary hyperplasia, incontrast to the absence of expression in normal parathyroidtissue. A marked expression of EGF-R mRNA and protein was alsofound in four of five tissue samples of primary parathyroidadenoma, in 13 of 15 tissue samples of secondary parathyroidhyperplasia and in most samples of normal parathyroid glandtissue. EGF mRNA and protein expression was undetectable inthe majority of parathyroid tissue samples examined. CONCLUSION.: Since TGF- is known to bind to the EGF-R, the finding of anincreased expression of TGF- at the gene message and the proteinlevel, together with a strong expression of EGF-R, in hyperplasticand adenomatous parathyroid glands suggests that this growthfactor interacts with its receptor to promote parathyroid cellproliferation, perhaps by an autocrine mechanism.     

Does multiple gland disease in primary hyperparathyroidism correlate with age or sex?

Purpose  Paediatric primary hyperparathyroidism (PHPT) patients suffer more often from multiple gland disease (MGD) than adults. The question occurs whether MGD in adult PHPT patients also correlates with age or sex and whether familial PHPT plays a decisive role. This is significant, as it would influence our decision for a focused approach or the bilateral cervical exploration. Materials and methods  We retrospectively analysed 465 consecutive PHPT patients who underwent surgery in our department between September 2001 and December 2008. Results  PHPT patients aged 40 years or younger suffered significantly more often from MGD than older patients (22.9% versus 11.0%). If familial PHPT disorders, which were more common in young patients, were excluded, the divergence between these two groups vanished (12.5% versus 10.0%). There was no statistical significant difference in the frequency of MGD between men (12.2%) and women (12.3%). Conclusions  If familial PHPT can be ruled out, the frequency of MGD in adult PHPT patients does not correlate with age or with sex. Therefore, age and sex do not imply specific surgical approaches in adult PHPT patients. Best of Endocrine Surgery in Europe 2009.