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.%目的：探讨原发性甲状旁腺功能亢进症( primary hyperparathyroidism, PHPT)的临床特点、误诊原因及防范措施。方法回顾性分析2010年1月—2014年1月成都医学院第一附属医院收治的曾误诊的PHPT 7例的临床资料,并复习相关文献。结果本组全段甲状旁腺激素( iPTH)水平均明显增高,均合并重度骨质疏松,初次就诊均误诊,4例在骨科就诊误诊为腰椎间盘突出、骨囊肿、转移性骨肿瘤及骨纤维结构不良各1例,1例在心血管内科就诊误诊为冠心病、高血压,1例在泌尿外科就诊长期误诊为单纯泌尿系统结石、慢性梗阻性肾病；1例首诊于某三甲医院内分泌专科误诊为肾小管疾病。误诊时间2个月~10年(4.74±2.94)年。6例行甲状旁腺肿瘤切除并病理检查,结果显示甲状旁腺瘤4例,多发甲状旁腺瘤及甲状旁腺癌各1例,其中5例术后随访1~11个月,血钙、iPTH降至正常；1例术后iPTH未降至正常,因败血症、全身衰竭死亡。1例经同步血钙及iPTH测定确诊PHPT,因年龄较大且合并冠心病、高钙危象,导致严重脱水诱发急性肾损伤、心肌梗死、意识障碍,确诊后2 d死亡。结论 PHPT误诊的主要原因是临床表现缺乏特异性、临床医生对其认识不足及忽略常规检测血钙和甲状旁腺激素( PTH)。提示临床遇及疑似PHPT患者应积极筛查血钙、PTH、骨密度,以早期诊断、合理治疗。
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