临床误诊误治Issue(8)：17-20,4.DOI:10.3969/j.issn.1002-3429.2015.08.008
原发性甲状旁腺功能亢进症七例误诊分析及文献复习
Analysis of 7 Misdiagnosed Cases of Primary Hyperparathyroidism and the Related Literature Review
摘要
Abstract
Objective To investigate clinical features, misdiagnosed causes and preventive measures of primary hy-perparathyroidism ( PHPT) . Methods The clinical data of seven misdiagnosed cases of PHPT during January 2010 and Jan-uary 2014 in the first affiliated hospital of Chengdu Medical College were analyzed retrospectively. The relevant literature was reviewed. Results All the cases had apparent increased intact parathyroid hormone ( iPTH) complicated with severe osteopo-rosis and were misdiagnosed at the first visit. Four patients were misdiagnosed with lumbar disc herniation, bone cysts, meta-static tumors, or fibrocartilaginous dysplasia respectively in orthopedics department. 1 case was misdiagnosed as coronary heart disease and hypertension in cardiovascular department. 1 case had pure renal calculus and chronic obstructive nephropathy for a long period of time in urinary surgery department. 1 case was mistaken for renal tubular diseases because of normocalcemic PHPT at the first visit in other tertiary hospitals. The misdiagnosed time was from 2 months to 10 years ( average time was 4. 74 ± 2. 94 years). 6 patients underwent surgery, and postoperative pathological diagnosis confirmed 4 cases of parathyroid adenoma;1 case of multiple parathyroid adenomas and 1 case of parathyroid carcinoma. After surgery, 5 patients were fol-lowed up from 1 to 11 months and the blood calcium and iPTH level decreased to normal limit;1 patient died of sepsis and systemic failure with elevated iPTH level. 1 patient died of hypercalcaemia crisis, complicated with acute kidney injures myo-cardial infarction and consciousness disturbance 2 days after diagnosis was confirmed. Conclusion The major cause for mis-diagnosis of PHPT is lack of clinical specificity and insufficient awareness of the disease by clinicians. Serum calcium, serum parathyroid hormone and bone density should be screened for suspected patients in order to make early diagnosis and rational treatment of PHPT patients.关键词
甲状旁腺功能亢进症/误诊/转移性骨肿瘤/骨囊肿/冠心病Key words
Hyperparathyroidism/Misdiagnosis/Metastatic bone neoplasm/Bone cyst/Coronary heart disease分类
医药卫生引用本文复制引用
邱平,唐明薇,梅希,兰天,廖戮缪,黎瑶..原发性甲状旁腺功能亢进症七例误诊分析及文献复习[J].临床误诊误治,2015,(8):17-20,4.基金项目
四川省卫生厅课题(120478) （120478）
