Hyperparathyroidism with hypercalcaemia in chronic kidney disease: primary or tertiary?
Hyperparathyroidism with hypercalcaemia in chronic kidney disease: primary or tertiary?
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DOI：
10.1093/ndtplus/sfq077
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发表时间：
2010-08-01
影响因子：
4.6
通讯作者：
Chertow, Glenn M.
中科院分区：
文献类型：
--
作者：
Lunn, Mitchell R.;Mendoza, Jair Munoz;Chertow, Glenn M.
目标。本研究旨在强调在晚期慢性肾病（CKD）患者中诊断甲状旁腺功能亢进（HPT）的挑战。在本报告中，我们描述了一位菲律宾中年男子，他患有潜在的CKD，表现为难治性恶心，呕吐，严重且医学难治性高钙血症和甲状旁腺激素（PTH）浓度超过2400 pg/mL。本文讨论了潜在的病理生理、病因和目前的相关文献。我们还建议采用适当的诊断方法来识别和及时治疗CKD， HPT和高钙血症患者。评估证实存在一个大甲状旁腺瘤；HPT和高钙血症在切除后迅速消退。该病例报告因其需要血液透析的严重高钙血症、大的腺瘤大小、急性慢性肾损伤和与原发性HPT相关的PTH浓度显著升高而引人注目。
Objective. This study aims to highlight the challenges in the diagnosis of hyperparathyroidism (HPT) in patients with advanced chronic kidney disease (CKD).Methods. In this report, we describe a middle-aged Filipino gentleman with underlying CKD who presented with intractable nausea, vomiting, severe and medically refractory hypercalcaemia and parathyroid hormone (PTH) concentrations in excess of 2400 pg/mL. The underlying pathophysiology as well as the aetiologies and current relevant literature are discussed. We also suggest an appropriate diagnostic approach to identify and promptly treat patients with CKD, HPT and hypercalcaemia.Results. Evaluation confirmed the presence of a large parathyroid adenoma; HPT and hypercalcaemia resolved rapidly following resection.Conclusion. This case report is remarkable for its severe hypercalcaemia requiring haemodialysis, large adenoma size, acute-on-chronic kidney injury and markedly elevated PTH concentration in association with primary HPT in CKD.