Recidivujúca hyperkalciémia – ťažký diagnostický oriešok: kazuistika
Relapsing hypercalcemia – a hard diagnostic nut to crack: a case report
The two most common causes of hypercalcemia are the primary hyperparathyroidism and the malignant tumors. Etiology of primary hyperparathyroidism is frequently associated with adenoma of parathyroid gland, less frequently with hyperplasia of parathyroid gland and rarely with carcinoma of parathyroid gland. In below presented clinical case we demonstrate the rare case of the premenopausal woman indicated with an anamnesis of bone pain, densitometric examination showed significantly decreased bone density and laboratory results proved hypercalcemia, hypophosphatemia and significantly increased parathormone level. After successful surgery of the right lower parathyroid gland adenoma there has been expected decline in serum calcium and parathormone level. At the subsequent visit, a relapse of hypercalcemia and an increase of parathormone level appeared, furthermore a new solitary node in the left thyroid lobe has been diagnosed. After subsequent detailed examination, the node has been diagnosed as the parathyroid carcinoma with atypical location in the thyroid left lobe.
Keywords:
alkaline phosphatase – hypercalcemia – parathyroid adenoma – parathyroid hormone (PTH) – primary hyperparathyroidism (PHPT) – Z-score
Autoři:
Halmová Henrieta 1; Halm Filip 2; Vaňuga Peter 3; Sičák Marián 4; Szépe Peter 5; Slávik Matej 7
Působiště autorů:
Endokrinologická ambulancia OSTEOMED, s. r. o., Lučenec
1; Radiodiagnostické oddělení Nemocnice Na Homolce, Praha
2; Endokrinologické oddelenie NEDÚ, Ľubochňa
3; ORL klinika, Ústredná vojenská nemocnica SNP Ružomberok – FN
4; Ústav patologickej anatómie JLF UK a UN Martin
5; Martinské bioptické centrum, s. r. o., Martin
6; Ústav patologickej anatómie, Ústredná vojenská nemocnica SNP Ružomberok – FN
7
Vyšlo v časopise:
Clinical Osteology 2021; 26(1): 44-52
Kategorie:
Souhrn
Dve najčastejšie príčiny hyperkalciémie sú primárna hyperparatyreóza a malígne nádory. Etiológia primárnej hyperparatyreózy je často spojená s adenómom prištítneho telieska, ojedinele s hyperpláziou prištítnych teliesok a vzácne s karcinómom prištítneho telieska. V kazuistike uvádzame raritný prípad pacientky v premenopauzálnom veku, s anamnézou bolesti v skelete, denzitometrickým vyšetrením potvrdenou výrazne zníženou kostnou denzitou, laboratórne s hyperkalciémiou, hypofosfatémiou a výraznou eleváciou hladiny parathormónu. Po operačnom odstránení adenómu pravého dolného prištítneho telieska je na pooperačnej kontrole prítomné očakávané zníženie hladiny Ca a PTH. Pri ďalšej kontrole dochádza k relapsu hyperkalciémie a elevácie PTH, s de novo diagnostikovaným uzlom v ľavom laloku štítnej žľazy, z ktorého sa po podrobnom vyšetrení potvrdil primárny karcinóm prištítneho telieska, lokalizovaný atypicky v štítnej žľaze.
Zdroje
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- Digonnet A, Carlier A, Willemse E et al. Parathyroid carcinoma: a review with three illustrative cases. J Cancer 2011; 2: 532–537. Dostupné z DOI: <http://dx.doi.org/10.7150/jca.2.532>.
Štítky
Clinical biochemistry Paediatric gynaecology Paediatric radiology Paediatric rheumatology Endocrinology Gynaecology and obstetrics Internal medicine Orthopaedics General practitioner for adults Radiodiagnostics Rehabilitation Rheumatology Traumatology OsteologyČlánok vyšiel v časopise
Clinical Osteology
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