您的位置：山东大学 -> 科技期刊社 -> 《山东大学学报（医学版）》

山东大学学报 (医学版) ›› 2023, Vol. 61 ›› Issue (1): 62-68.doi: 10.6040/j.issn.1671-7554.0.2022.0851

• 临床医学 • 上一篇    

以甲状旁腺危象为首发表现的甲状旁腺癌1例文献报道

曾彦平1,2,闫圣涛3,刘小瑜4,江子晴1   

  1. 1.广州中医药大学第一临床医学院, 广东 广州 510405;2.广州中医药大学第一附属医院急诊科, 广东 广州 510405;3.中日友好医院急诊科, 北京 100029;4.北京协和医学院研究生院, 北京 100730
  • 发布日期:2023-01-10
  • 通讯作者: 闫圣涛. E-mail:yanshengtaozrr@126.com
  • 基金资助:
    市校(院)联合资助项目基础与应用基础研究项目(202201020289)

A case report of parathyroid carcinoma with parathyroid crisis as the primary clinical manifestation

ZENG Yanping1,2, YAN Shengtao3, LIU Xiaoyu4, JIANG Ziqing1   

  1. 1. The First Clinical College, Guangzhou University of Chinese Medicine, Guangzhou 510405, Guangdong, China;
    2. Emergency Department, the First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou 510405, Guangdong, China;
    3. Emergency Department, China-Japan Friendship Hospital, Beijing 100029, China;
    4. Graduate School of Peking Union Medical Collage, Beijing 100730, China
  • Published:2023-01-10

PDF (PC)

137

摘要： 目的 通过1例以甲状旁腺危象为首要临床表现,病理确诊为甲状旁腺癌的诊治过程进行分析报道,以期提高临床医师对该罕见病的认识。 方法 收集1例首诊为甲状旁腺危象,最终确诊为甲状旁腺癌患者的临床及实验室检查资料进行总结分析,并复习相关文献,对该病的诊治思路进行归纳总结。 结果 患者,女,70岁,以意识障碍、严重高血钙、甲状旁腺激素(PTH)异常升高、肺部感染、肾功能不全、下肢静脉血栓为首要临床表现就诊,通过抗感染、鲑降钙素、地舒单抗、抗凝等治疗后,病情曾一度好转,随后再次出现恶化。通过二次评估,采取升级抗感染、盐酸西那卡塞片治疗高钙血症、扩容等治疗后,患者病情稳定好转,为手术治疗创造条件。最终通过术后大体病理标本,确诊为甲状旁腺癌。 结论 甲状腺周围结节、血钙> 3.5 mmol/L,PTH大于正常值上限10倍,均提示甲状旁腺癌可能。颈部超声与99mTc-MIBI两者相结合,可提高检测率。内科保守治疗虽然可以缓解临床症状,但手术仍是治疗的关键。扩大切缘对肿瘤的清除可能获益,但目前尚无统一标准。此病复发率高,长期跟踪随访、及时治疗可能提高生存率。

关键词: 甲状旁腺危象, 甲状旁腺癌, 高钙血症, 手术治疗

Abstract: Objective To analyze and report the diagnosis and treatment of a case of pathologically confirmed parathyroid carcinoma with parathyroid crisis as the primary clinical manifestation, in order to improve clinicians understanding of this rare disease. Methods Clinical and laboratory examination data of a patient initially diagnosed as parathyroid crisis and finally diagnosed as parathyroid carcinoma were collected and analyzed, and relevant literature was reviewed. Results A 70-year-old female was admitted due to disorder of consciousness, severe hypercalcemia, abnormal elevation of parathyroid hormone(PTH), pneumonia, renal insufficiency, and venous thrombosis of lower limbs. After anti-infection, salmon calcitonin, desumumab, anticoagulation, and other treatments, the patients condition improved for a time, but then deteriorated again. After secondary evaluation, upgraded anti-infection, sinacaser hydrochloride tablets for hypercalcemia and dilation, the patients condition was stabled and improved, which created conditions for surgical treatment. Parathyroid carcinoma was finally confirmed by postoperative gross pathological specimens. Conclusion Peripheral thyroid nodules, serum calcium >3.5 mmol/L, and PTH >10 times of the upper limit of normal value, suggest the possibility of parathyroid carcinoma. The combination of neck ultrasound and 99mTc-MIBI can improve the detection accuracy. Surgery is still the key to treatment, although conservative medical treatment can relieve clinical symptoms. Extended resection margin may benefit tumor clearance, but there is no unified standard at present. Due to the high recurrence rate of this disease, long-term follow-up and timely treatment may improve the survival rate.

Key words: Parathyroid crisis, Parathyroid carcinoma, Hypercalcemia, Surgical treatment

中图分类号: 

  • R736.2
[1] Xue S, Chen H, Lv C, et al. Preoperative diagnosis and prognosis in 40 Parathyroid Carcinoma Patients [J]. Clin Endocrinol(Oxf), 2016, 85(1): 29-36.
[2] Ryhänen EM, Leijon H, Metso S, et al. A nationwide study on parathyroid carcinoma [J]. Acta Oncol, 2017, 56(7): 991-1003.
[3] Lee PK, Jarosek SL, Virnig BA, et al. Trends in the incidence and treatment of parathyroid cancer in the United States [J]. Cancer, 2007, 109(9): 1736-1741.
[4] Wang P, Xue S, Wang S, et al. Clinical characteristics and treatment outcomes of parathyroid carcinoma: a retrospective review of 234 cases [J]. Oncol Lett, 2017, 14(6): 7276-7282.
[5] Dogan U, Koc U, Mayir B, et al. Life-threatening intrathyroidal parathyroid adenoma [J]. Int J Clin Exp Med, 2015, 8(1): 1501-1503.
[6] Bentata Y, El Maghraoui H, Benabdelhak M, et al. Management of hypercalcaemic crisis in adults: current role of renal replacement therapy [J]. Am J Emerg Med, 2018, 36(6): 1053-1056.
[7] Torres PA, Helmstetter JA, Kaye AM, et al. Rhabdomyolysis: pathogenesis, diagnosis, and treatment [J]. Ochsner J, 2015, 15(1): 58-69.
[8] Silverberg SJ, Rubin MR, Faiman C, et al. Cinacalcet hydrochloride reduces the serum calcium concentration in inoperable parathyroid carcinoma [J]. J Clin Endocrinol Metab, 2007, 92(10): 3803-3808.
[9] Takeuchi Y, Takahashi S, Miura D, et al. Cinacalcet hydrochloride relieves hypercalcemia in Japanese patients with parathyroid cancer and intractable primary hyperparathyroidism [J]. J Bone Miner Metab, 2017, 35(6): 616-622.
[10] Finsterer J. Trametinib and dabrafenib induced rhabdomyolysis,renal failure,and visual loss. Report of one case [J]. Rev Med Chil, 2020, 148(11): 1684-1689.
[11] Hu Y, Bi Y, Cui M, et al. The influence of surgical extent and parafibromin staining on the outcome of parathyroid carcinoma: 20-year experience from a single institute [J]. Endocr Pract, 2019, 25(7): 634-641.
[12] Lenschow C, Schrägle S, Kircher S, et al. Clinical presentation, treatment, and outcome of parathyroid carcinoma: results of the NEKAR retrospective international multicenter study [J]. Ann Surg, 2022, 275(2): e479-e487.
[13] Phitayakorn R, McHenry CR. Incidence and location of ectopic abnormal parathyroid glands [J]. Am J Surg, 2006, 191(3): 418-423.
[14] 张翔, 胡亚, 王梦一, 等. 原发性甲状旁腺功能亢进症的术前诊断与外科治疗策略[J]. 中华内分泌外科杂志, 2018, 12(4): 274-277. ZHANG Xiang, HU Ya, WANG Mengyi, et al. Preoperative diagnosis and surgical strategies of primary hyperparathyroidism [J]. Chinese Journal of Endocrine Surgery, 2018, 12(4): 272-277.
[15] 肇冬梅, 章志丹, 栾正刚, 等. 原发性甲状旁腺功能亢进症危象合并多器官功能损伤四例并文献复习[J]. 中华内科杂志, 2016, 55(2):138-140. ZHAO Dongmei, ZHANG Zhidan, LUAN Zhenggang, et al. Primary hyperparathyroidism crisis with multiple organ dysfunction: a report of four cases and literature review [J]. Chinese Journal of Internal Medicine, 2016, 55(2): 138-140.
[16] Rickles FR, Edwards RL. Activation of blood coagulation in cancer: Trousseaus syndrome revisited [J]. Blood, 1983, 62(1): 14-31.
[17] 中国临床肿瘤学会肿瘤与血栓专家共识委员会. 肿瘤相关静脉血栓栓塞症的预防与治疗中国专家指南(2015版)[J]. 中国肿瘤临床, 2016, 43(7): 274. Expert Consensus Committee on Tumor and Thrombosis, Chinese Society of Clinical Oncology. Prevention and treatment of tumor associated venous thromboembolism: a Chinses expert guide [J]. Chinese Journal of Clinical Oncology, 2016, 43(7): 274.
[18] Lyman GH, Carrier M, Ay C, et al. American Society of Hematology 2021 guidelines for management of venous thromboembolism: prevention and treatment in patients with cancer [J]. Blood Adv, 2021, 5(4): 927-974.
[19] 王培松, 薛帅, 王硕, 等. 中国甲状旁腺癌234例分析[J]. 中华内分泌外科杂志, 2017, 11(4): 334-337. WANG Peisong, XUE Shuai, WANG Shuo, et al. 234 cases of parathyroid carcinoma [J]. Chinese Journal of Endocrine Surgery, 2017, 11(4): 334-337.
[20] Cetani F, Pardi E, Marcocci C. Parathyroid Carcinoma [J]. Front Horm Res, 2019, 51: 63-76. doi: 10.1159/000491039.
[21] Salcuni AS, Cetani F, Guarnieri V, et al. Parathyroid carcinoma [J]. Best Pract Res Clin Endocrinol Metab, 2018, 32(6): 877-889.
[22] Thanseer NTK, Parihar AS, Sood A, et al. Evaluation of recurrent parathyroid carcinoma: a new imaging tool in uncommon entity [J]. World J Nucl Med, 2019, 18(2): 198-200.
[23] 胡亚, 廖泉. 甲状旁腺癌分子机制研究现状及临床应用前景[J]. 中华内分泌代谢杂志, 2020, 36(6): 537-540. HU Ya, LIAO Quan. The research of molecular mechanism for parathyroid carcinoma and prospects of clinical application [J]. Chinese Journal of Endocrinology and Metabolism, 2020, 36(6): 537-540.
[24] Young S, Wu JX, Li N, et al. More extensive surgery may not improve survival over parathyroidectomy alone in parathyroid carcinoma [J]. Ann Surg Oncol, 2016, 23(9): 2898-2904.
[25] Lee PK, Jarosek SL, Virnig BA, et al. Trends in the incidence and treatment of parathyroid cancer in the United States [J]. Cancer, 2007, 109(9): 1736-1741.
[26] ONeill CJ, Chan C, Symons J, et al. Parathyroid carcinoma encountered after minimally invasive focused parathyroidectomy may not require further radical surgery [J]. World J Surg, 2011, 35(1): 147-153.
[27] Kruijff S, Sidhu SB, Sywak MS, et al. Negative parafibromin staining predicts malignant behavior in atypical parathyroid adenomas [J]. Ann Surg Oncol, 2014, 21(2): 426-433.
[28] Iihara M, Okamoto T, Suzuki R, et al. Functional parathyroid carcinoma: long-term treatment outcome and risk factor analysis [J]. Surgery, 2007, 142(6): 936-943.
[29] Hu Y, Cui M, Bi Y, et al. Immunocyte density in parathyroid carcinoma is correlated with disease relapse [J]. J Endocrinol Invest, 2020, 43(10): 1453-1461.
[1] 靳鲁珺,林雪艳,刘天航,李青,李晓文,房蕾,孙浩,田永杰. 重度盆腔器官脱垂患者治疗选择及影响因素[J]. 山东大学学报 (医学版), 2022, 60(12): 39-43.
[2] 王沂峰,何丽清. 外阴癌腹股沟淋巴结手术的研究进展[J]. 山东大学学报 (医学版), 2021, 59(9): 103-109.
[3] 毕亚珍,冯洒然,李红,刘倩,于靖宜,王焱,朱传升. 以高钙血症为首发表现的成人急性髓系白血病1例报告[J]. 山东大学学报 (医学版), 2021, 59(5): 116-118.
[4] 霍素霞,刘薇,王鑫. 86例Ⅲ型瘢痕妊娠诊治体会[J]. 山东大学学报 (医学版), 2021, 59(1): 40-44.
[5] 孙志刚,时鹏,田兴松. 乳腺癌术后促纤维增生性肌纤维母细胞瘤1例[J]. 山东大学学报 (医学版), 2020, 58(1): 121-124.
[6] 姚旭东. 局部晚期前列腺癌手术治疗策略及疗效[J]. 山东大学学报 (医学版), 2019, 57(1): 21-25.
[7] 蒋洁,张晓黎,董明,刘金波,蒋玲. 肿瘤相关性骨软化症3例分析并文献复习[J]. 山东大学学报（医学版）, 2017, 55(5): 108-111.
[8] 刘涛,鲍飞龙,高伟,亢世杰,吕夫新,胡义明. 肘关节内翻后内侧旋转不稳的手术疗效[J]. 山东大学学报（医学版）, 2016, 54(12): 41-45.
[9] 陆福鼎, 玄绪军, 许可慰, 毕良宽. 单纯性阴茎弯曲畸形手术治疗的选择及体会[J]. 山东大学学报（医学版）, 2014, 52(10): 86-89.
[10] 曹伟，辛涛，刘威，张永超. 桥小脑角区肿瘤术后隐匿性脑脊液漏临床分析[J]. 山东大学学报(医学版), 2013, 51(12): 78-81.
[11] 房建伟1,刘凡英1,李军1,2. 肺硬化性血管瘤的临床特点及外科治疗[J]. 山东大学学报(医学版), 2011, 49(2): 83-87.
[12] 陈秀梅，张庆泉. 鼻内镜下鼻中隔偏曲矫正治疗鼻内接触性头痛[J]. 山东大学学报(医学版), 2011, 49(11): 128-130.
[13] 刘西花1，高杰2，岳寿伟1. 快速牵引联合骶裂孔注射治疗腰椎间盘突出症疗效的影响因素研究[J]. 山东大学学报(医学版), 2010, 48(9): 113-116.
[14] 郑志明,滕良珠,辛涛,张永超. 垂体脓肿的诊断和治疗（7例临床分析)[J]. 山东大学学报(医学版), 2007, 45(11): 1186-1188.
Viewed
Full text


Abstract

Cited
  Shared   
  Discussed   
No Suggested Reading articles found!
版权所有 © 2018 《山东大学学报(医学版)》编辑部　
地址:山东大学科技期刊社（济南市历城区山大南路27号山东大学中心校区明德楼B座721室） 电话: 0531-88366918 E-mail: xbyxb@sdu.edu.cn
本系统由北京玛格泰克科技发展有限公司设计开发