Hyperparathyroid crisis: clinical and pathologic studies of 14 patients.
Hyperparathyroid crisis: clinical and pathologic studies of 14 patients.
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DOI：
10.1097/00000658-197912000-00019
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发表时间：
1979-12
影响因子：
9
通讯作者：
C. Wang;S. Guyton
中科院分区：
文献类型：
--
作者：
C. Wang;S. Guyton
本文报告1964年至1978年在马萨诸塞州总医院治疗的14例甲状旁腺危象患者。这些患者表现出多种临床表现，与假性甲状旁腺功能亢进患者难以区分。他们的症状从进行性疲劳、不适和虚弱到与胃肠道和泌尿道相关的症状不等。在这些患者中常见的一种生化改变是血清钙的快速增加。50%的患者BUN和80%的患者肌酐同时升高。诊断建立了一个升高的免疫反应性甲状旁腺激素（PTH）的水平在所有8例（100%）谁有放射免疫测定;的存在下骨膜下吸收的趾骨的8例（75%）;和在3个四例（75%）的牙齿硬脑膜的损失。12名接受手术的患者全部存活，2名未接受手术的患者死亡。13名患者（93%）有肿瘤-12名腺瘤和1名癌。1例患者有增生（7%）。9例患者（64%）接受了低钙药物治疗。5名患者（56%）的血清钙暂时降至12 mg/100 ml，但4名患者（44%）未发生变化。同时输注生理盐水、呋塞米和低钙药物长期治疗增加了间质水肿，增加了手术难度。我们的研究结果表明，及时的手术干预是甲状旁腺危象的理想治疗方法，最好是在症状急性发作后72小时内。
A study is presented of 14 patients with hyperparathyroid crisis treated at the Massachusetts General Hospital between 1964 and 1978. These patients showed diverse clinical manifestations that were indistinguishable from those in patients with pseudohyperparathyroidism. Their symptoms varied from progressive fatigue, malaise, and weakness to those related to the gastrointestinal and urinary tracts. The one biochemical alteration commonly found among these patients was the rapid increase in the serum calcium. There was a concomitant rise in the BUN in 50% of the patients and in the creatinine in 80%. The diagnosis was established by an elevated immunoreactive parathyroid hormone (PTH) level in all eight patients (100%) who had the radioimmunoassay; by the presence of subperiosteal resorption of the phalanges in six of the eight patients (75%); and in three of four patients (75%) by the loss of the lamina dura of the teeth. The 12 patients who had surgery all survived; the two who did not died. Thirteen patients (93%) had a neoplasm--an adenoma in 12 and a carcinoma in one. One patient had hyperplasia (7%). Nine patients (64%) received hypocalcemic drug therapy. The serum calcium temporarily fell to 12 mg/100 ml in five patients (56%) but failed to budge in four (44%). Simultaneous treatment with saline infusion, furosemide and with hypocalcemic drugs over a prolonged period compounded the difficulty at operation by increasing interstitial edema. Our findings from this study show prompt surgical intervention as the ideal treatment for hyperparathyroid crisis, preferably, within 72 hours of the acute onset of symptoms.