首页> 外文期刊>Nature clinical practice. Endocrinology & metabolism >A patient with persistent primary hyperparathyroidism due to a second ectopic adenoma.
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A patient with persistent primary hyperparathyroidism due to a second ectopic adenoma.

机译:由于第二次异位腺瘤而持续存在原发性甲状旁腺功能亢进的患者。

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BACKGROUND: A 33-year-old woman presented with recurrent renal stones and malaise to her primary-care physician. Laboratory investigations revealed the patient had hypercalcemia and an elevated serum parathyroid hormone concentration. A diagnosis of primary hyperparathyroidism was established and the patient was referred for parathyroidectomy. At neck exploration, three parathyroid glands were visualized, one of which was enlarged and subsequently removed. The patient's serum calcium and parathyroid hormone levels decreased postoperatively but did not normalize, and her symptoms persisted. Planar (99m)Tc-sestamibi and ultrasound scans failed to provide conclusive localization for another enlarged parathyroid gland. The patient was referred to our Endocrinology Unit for further investigations and management. INVESTIGATIONS: Laboratory investigations, ultrasound of the kidneys, BMD measurements, selective venous sampling for parathyroid hormone, and (99m)Tc-sestamibi single photon emission CT imaging. DIAGNOSIS: Persistent hyperparathyroidism due to an ectopically located parathyroid adenoma. MANAGEMENT: At further neck exploration, a 1.5 cm by 0.7 cm by 0.5 cm ectopic parathyroid adenoma was excised from the site indicated by the localization studies. No further exploration was attempted after intraoperative parathyroid hormone levels fell by 70%. Serum calcium levels and 24 h urine excretion of calcium rapidly normalized and all of the patient's symptoms completely disappeared within a few weeks of surgery.
机译:背景:一名33岁的妇女向其初级保健医生出现了反复出现的肾结石和不适。实验室检查显示该患者有高钙血症和血清甲状旁腺激素浓度升高。确定了原发性甲状旁腺功能亢进症的诊断,并将患者转诊进行甲状旁腺切除术。在颈部探查时,可以看到三个甲状旁腺,其中一个被扩大并随后切除。术后患者的血清钙和甲状旁腺激素水平降低,但未恢复正常,症状持续。平面(99m)Tc-西他米比和超声扫描未能为另一个扩大的甲状旁腺提供确切的定位。该患者被转介到我们的内分泌科进行进一步的检查和处理。调查:实验室检查,肾脏超声检查,BMD测量,甲状旁腺激素的选择性静脉取样以及(99m)Tc-司他他比单光子发射CT成像。诊断:由于异位的甲状旁腺腺瘤导致的持续性甲状旁腺功能亢进。处理:在进一步的颈部探查中,从本地化研究表明的部位切除了一个1.5 cm x 0.7 cm x 0.5 cm的异位甲状旁腺腺瘤。术中甲状旁腺激素水平降低70%后,未尝试进一步探索。血清钙水平和24小时尿钙排泄迅速恢复正常,并且所有患者的症状在手术后几周内完全消失。

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