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頁籤選單縮合
題名 | A Patient of Primary Hyperparathyroidism with Full-Blown Bone Changes Simulating Malignancy=類似骨骼惡性腫瘤的原發性副甲狀腺高能症之完整骨骼變化--一病例報告 |
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作者 | 莊東璋; 張哲銘; 黃尚志; 蕭璧容; 賴永勳; | 書刊名 | The Kaohsiung Journal of Medical Sciences |
卷期 | 14:9 1998.09[民87.09] |
頁次 | 頁584-589 |
分類號 | 415.939 |
關鍵詞 | 骨骼變化; 惡性腫瘤; 原發性副甲狀腺高能症; 原發性副甲狀腺功能亢進症; 高鈣血症; Hypercalcemia; Primary hyperparathyroidism; Osteitis fibrosa cystica; |
語文 | 英文(English) |
中文摘要 | 引起高鈣血症最常見的原因是惡性腫瘤及原發性副甲狀腺功能亢進症。除了臨床 表徵不同外,X光上的骨骼變化在診斷上是非常重要的線索,例如骨質溶解的變化是多發性 骨髓瘤的特徵;而骨膜下吸收及囊性纖維性骨炎卻常見於副甲狀腺功能亢進症。本文報告一 43歲女性因右股骨骨折及高血鈣住院,偶然地在右脛骨處發現溶骨性的囊腫,邊緣呈現骨質 硬化的變化。血液及生化檢查發現有貧血、高血鈣、及腎功能不全。其他X光骨骼攝影則在 頭骨、兩側前臂、及右脛骨處,呈現多發性骨質溶解的變化。最初認為惡性腫瘤,例如多發 性骨髓瘤的可能性較大。但是血清蛋白電泳及骨切片檢查排除其可能性。而腹部腎臟-輸尿管 -膀胱攝影及腎臟超音波顯示兩側腎髓質結石,暗示了疾病的病程可能很久。由骨切片病理檢 查顯示典型棕色腫瘤,且副甲狀腺素高達1267.4pg/ml,進一步確定了副甲狀腺功能亢進症的 診斷。頸部超音波及副甲狀腺掃描確定病變為左下副甲狀腺腫瘤。細胞穿刺亦佐證其為副甲 狀腺細胞,於此確定診斷為原發性副甲狀腺功能亢進症。 由於生化檢查及副甲狀腺素測定的進步與廣泛運用,原發性副甲狀腺功能亢進症大部份 已在無症狀的高血鈣期即被診斷,對於以往為主要線索的骨骼病變於今反而少見。此病例於 高血鈣合併溶骨性病變的表現中,出現周圍硬化的囊性溶骨性特徵,在副甲狀腺素未測定之 前,提供了區分原發性副甲狀腺功能亢進症與其他具有溶骨性病變之惡性腫瘤的主要線索。 |
英文摘要 | The two most common causes of hypercalcemia are malignancy and primary hyperparathyroidism (1°HPT). The radiographic presentations and the histological findings on bone biopsy are important for differential diagnosis of underlying diseases. We report a patient with hypercalcemia who presented unusual bone manifestations. A 43 y/o woman was admitted due to right femoral fracture. X-ray on the right tibia revealed several osteolytic cystic lesions with sclerotic rims. Blood biochemistry showed anemia. impaired renal function and hypercalcemia. Multiple osteolytic lesions on the skull and bilateral forearms were also noted. Malignancy, such as multiple myeloma or metastatic cancer was suspected. However, this was excluded because of the absence of Mcomponent on serum protein electrophoresis and the negative finding of plasma cells or other malignant cell on bone biopsy examination. Abdominal sonography demonstrated bilateral medullary nephrocalcinosis. The final diagnosis of 1°HPT was made, based on the findings of classic pathological pictures (brown tumor) and the markedly elevated intact parathyroid hormone ( 1267.4 pg/ml ) level. Sonography on the neck and 201Tl / 99mTc parathyroid subtraction scan localized a left lower parathyroid tumor and fine needle aspiration confirmed the parathyroid origin. Diagnosis of 1°HPT could only be made from recurrent urolithiasis and X-ray picture of osteitis fibrosa cystica in the past. This patient presented the full-blown skeletal changes which are uncommonly seen nowadays. The characteristic sclerotic rims suggesting increased bone formation provides a further important clue for differential diagnosis of 1°HPT from other malignancies with osteolytic bone lesions. |
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