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題名 | Primary Hyperparathyroidism with Cardiac Abnormalities: A Case Report=原發性副甲狀腺機能亢進症合併心臟病變:一病例報告 |
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作者姓名(中文) | 楊純宜; 鄭成泉; 周劍文; 鄭弘美; | 書刊名 | 中華醫學雜誌 |
卷期 | 60:5 1997.11[民86.11] |
頁次 | 頁277-282 |
分類號 | 415.931 |
關鍵詞 | 心臟病變; 高血鈣; 原發性副甲狀腺機能亢進症; Cardiac abnormalities; Hypercalcemia; Primary hyperparathyroidism; |
語文 | 英文(English) |
中文摘要 | 原發性副甲狀腺機能亢進症特徵為副甲狀腺分泌過量副甲狀腺素,導致高血鈣及低血磷,並常見於老年人。大多數病人僅見輕微高血鈣無症狀,而少數人則合併各種器官病變,包括骨骼、腎臟、胃腸道、神經、肌肉、內分泌疾病及一般症狀。原發性副甲狀腺機能亢進症亦見合併心臟血管病變,包括心電圖變化(QT間隔縮短、心臟傳導阻斷、心律不整)、高血壓、心肌肥厚、心肌鈣化,但少見瓣膜性心臟病。我們報告一例原發性副甲狀腺機能亢進症合併心臟病變。病人為82歲男性,因為胸悶、疲倦、全身無力、噁心、嘔吐數月而入院。理學檢查發現心臟有雜音。實驗室檢查發現高血鈣(14.3mg/dl)及高血氯/血磷比例(>33)。內分泌血液檢查發現高副甲狀腺素(PTH-C4.8 ng/ml及PTH-intact 705 pg/ml)。腎臟超音波顯示腎結石,脊椎X光發現腰椎骨刺、壓迫性骨折及骨質疏鬆變化。頸部超音波及核子醫學掃描(Tl□-Tc□subtraction scan)顯示右下側副甲狀腺瘤。副甲狀腺抽取術顯示少數副甲狀腺。副甲狀腺抽取術顯示少數副甲狀腺細胞。心臟超音波顯示主動脈瓣鈣化及狹窄、心肌鈣化、中度主動脈瓣逆流及二尖瓣逆流。住院一個月後,病人接受手術治療切除右下副甲狀腺。手術後病人有短暫性肌肉抽筋及Trouseau's徵候及Chvostek's徵候。他接受鈣片及維生素丁以解除症狀並接受心臟藥物治療(diltiazem及capoten)。手術二個月後重覆心臟超音波檢查發現主動脈瓣膜鈣化及狹窄並無改善。 |
英文摘要 | Primary hyperparathyroidism, characterized by hypersecretion of parathyroid hormone (PTH) leading to hypercalcemia and relative hypophosphatemia, is quite common in the elderly. Most patients with primary yperparathyroidism have only mild hypercalcemia and are symptomless. But others experience various other organ diseases. Primary hyperparathyroidism is also associated with cardiovascular abnormalities, including QT interval shortening, heart block, cardiac arrhythmias, hypertension, myocardial hypertrophy, myocardial calcification and, though rarely, with valvular heart disease. We described a case of primary hyperparathyroidism associated with cardiac abnormalities. An 82-year-old male presented with the complaints of chest discomfort, fatigue, general weakness, nausea and vomiting over a period of months and was admitted in July 1996. Physical examination with heart auscultation showed a pansystolic murmur over the right sternal border and apex region, and a blowing diastolic murmur over the left sternal border. Biochemistry profiles revealed elevations of serum calcium (14.3 mg/dl) and chloride/phosphate ratio (>33). Endo-crinological studies showed elevations of serum PTH-C (4.8 ng/ml) and PTH-intact (705 pg/ml) concentrations. Kidney ultrasonography revealed a left renal stone. A spine X-ray revealed spondylosis and a compression fracture of the lumbar-spine with X-ray revealed spondylosis and a compression fracture of the lumbar-spine with osteoporotic change. Thyroid ultra-sonography and Thallium (Tl□)-technetium (Tc□) subtraction scan showed parathyroid adenoma in the low pole of the right thyroid bed. Parathyroid aspiration cytology revealed few and discrete cells. Echocardiogram revealed moderate to severe aortic valvular calcification as well as stenosis with moderater aortic regurgitation, mitral regurgitation and myocardial calcification. The patient received parthyroidectomy one month later. During his postoperative days, he suffered from muscle twitching with positive Trousseau's sing and Chvostek's sign. The patient received calcium carbonate and vitamin D for hypocalcemia, diltiazem and capoten for his heart problems. A repeated echocardiogram two months after surgery showed no improvement of valvular calcification. |
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