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甲状旁腺是调节人体钙磷代谢、维持体内钙磷稳定的主要器官。当甲状旁腺分泌过多的甲状旁腺激素(parathyroid hormone,PTH)时,易引发体内钙磷代谢紊乱及甲状旁腺功能亢进症(hyperparathyroidism,HPT)。HPT可分为原发性HPT、继发性HPT和三发性HPT。其中继发性HPT和三发性HPT常见于慢性肾功能衰竭患者;三发性HPT是部分继发性HPT患者增生的甲状旁腺组织长期受到各种原因引起的低血钙或高血磷的刺激,部分转变为具有自主分泌功能的腺瘤从而过度分泌PTH的综合征[1]。部分增生甲状旁腺组织转变为腺瘤是三发性HPT典型的病理征象。甲状旁腺腺瘤通常较小,直径为4~25 mm,重量为70 mg~1 g,当病灶>2 g时即称为巨大甲状旁腺腺瘤[2]。笔者通过该病例及相关文献的复习加深对三发性HPT的认识。
三发性甲状旁腺功能亢进伴巨大甲状旁腺腺瘤99Tcm-MIBI SPECT/CT显像一例
Case study of triple hyperparathyroidism with giant parathyroid adenoma showed by 99Tcm-MIBI SPECT/CT imaging
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摘要: 笔者报道了1例三发性甲状旁腺功能亢进(HPT)伴巨大甲状旁腺腺瘤的99Tcm-MIBI SPECT/CT显像病例。从临床症状、实验室检查及影像学检查结果综合分析了该病的特点,通过文献复习加深了对三发性HPT的认识。三发性HPT常见于慢性肾功能不全的透析患者,其甲状旁腺长期受到低血钙的刺激,部分组织增生后转变为具有自主分泌功能的腺瘤,其发病率较低,内科治疗效果欠佳,及时进行99Tcm-MIBI SPECT/CT显像可以进一步定性、定位,利于为患者选择更为合适的治疗方案。Abstract: A case of triple hyperparathyroidism with giant parathyroid adenoma showed by 99Tcm-MIBI SPECT/CT imaging was reported. The characteristics of the disease were analyzed from clinical symptoms, laboratory examinations, and imaging tests. Triple hyperparathyroidism(HPT), which is common in dialysis patients with chronic renal insufficiency, was deeply analyzed through literature review. The parathyroid glands are stimulated by hypocalcemia for a long time, and some tissues proliferate and turn into adenomas with autocrine function. The incidence of triple HPT is low, and the effect of medical treatment is poor. Timely 99Tcm-MIBI SPECT/CT imaging can be further qualitative and localized to facilitate the selection of appropriate treatment options.
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图 1 三发性甲状旁腺功能亢进伴巨大甲状旁腺腺瘤患者(男性,47岁)的99Tcm-MIBI 双时相平面显像(A)、SPECT/CT断层融合显像(B)、超声显像(C)和术后病理图(D)
Figure 1. 99Tcm-MIBI dual phase planar imaging (A), SPECT/CT fusion imaging (B), ultrasound imaging (C) and pathological section of triple hyperparathyroidism with giant parathyroid adenoma (D) (male, 47 years old)
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