原发性甲状旁腺功能亢进性骨病

目的提高原发性甲状旁腺功能亢进性骨病的早期诊断及治疗效果。方法回顾分析4例骨型原发性甲状旁腺功能亢进症患者的临床资料及随访结果。其中男性2例,女性2例;平均年龄35岁(21～51岁)。临床症状包括疼痛、肿胀,伴有乏力、胃肠不适及体重下降,1例发生病理性骨折,X线表现多发溶骨性病损,核素扫描显示多部位骨骼核素浓聚。实验室检查:血钙:2.23～3.99mmol/L,甲状旁腺素:644～1664pg/ml。全部患者转入头颈部肿瘤外科,手术后确诊甲状旁腺腺瘤3例,甲状旁腺腺癌1例。结果平均随访42个月(8～96个月)。所有患者骨科症状好转,3例术后1.5年骨病损痊愈。甲状旁腺肿瘤无复发及转移。结论早期诊断、及时手术治疗可避免骨型原发性甲状旁腺功能亢进症引起的骨病损加重。除预计可能出现严重的骨相关事件外,骨病损可不作特殊骨科治疗。

Multiple osteitis fibroca cystica secondary to primary hyperparathyroidism: a report of 4 cases

Objective To improve the accuracy of early diagnosis and therapeutic effectiveness for the multiple osteitis fibroca cystica seconderay to primary hyperparathyroidism.Methods The clinical data and follow-up results were analysed retrospctively.Among the 4 patients,2 males,2 females.The age ranged from 21 to 51 years(35 years in average).All the patients complained of pain and swelling over the affected sites,accompanied with fatigue,poor appetite and weight-loss.Pathological fracture occurred in one patient.Radiographic evaluation demonstrated multiple osteolytic lesions and the bone scan revealed multiple isotope-condense hot spots.Lab examinations showed that the level of serum calcium ranged from 2.23 to 3.99mmol/L and PTH from 644 to 1644pg/ml.All patients underwent parathyroidectomy.The pathological diagnosis was parathyroid adenomas in 3 cases and parathyroid carcinoma in 1 case.Results The average time of follow-up was 42 mons(8-96 months);Symptom relief was found in all cases and the partial or complete healing of osteolytic lesions was discovered in radiographic evaluations during follow-up.No evidence of recurrence or metastasis of the primary tumor of parathyroid found at follow-up.Conclusions Early diagnosis and parathyroidectomy may control the hyperparathyroidism and consequently inhibit its osteolytic effect.The additional surgical management should be given to the osteolytic lesions only in the case of the high risk of fracture.the patient with