Mediastinal Parathyroid Adenoma: A Case Report

縱膈腔副甲狀腺腺瘤病例報告及文獻回顧

張宏(Hung Chang) ； 陳仁智(Jen-Chih Chen) ； 聶鑫(Hsien Nieh) ； 李世俊(Shih-Chun Lee)

《胸腔醫學》 18卷4期 (2003/08) Pp. 338-343

摘要

縱膈腔副甲狀腺腺瘤能導致持續性高血鈣，精確定位及以適當方式移除仍然是一個難題。一位五十二歲女性遭受腎絞痛頻頻發作及持續性高血鈣之苦，雖經內視鏡檢、體外震波碎石及導管引流治療後，腎絞痛仍然持續。實驗室檢查顯示高血鈣及高副甲狀腺核爾蒙，胸部電腦斷層掃瞄發現在主動脈–肺動脈窗處有一腫瘤，核子醫學掃瞄顯示在氣管分叉前放射線活性有意義的增加。在診斷出縱膈腔副甲狀腺腺瘤後以左側開胸術移除腫瘤，術後血鈣及副甲狀腺賀爾蒙恢復正常。報告此治療成功案例並討論如何精確定位及移除深藏於縱膈腔之副甲狀腺腺瘤。

關鍵字

縱膈腔副甲狀腺腺瘤 ； 高血鈣 ； 甲狀腺賀爾蒙

並列摘要

Mediastinal parathyroid adenoma can cause persistent hyperparathyroidism with hypercalcemia. Accurately locating and removing the adenoma, using an appropriate, is very dufficult. A 52-year-old woman suffered from frequent attacks of renal colic and persistent hypercalcemia. Even after ureteroscopy with electrohydraulic lithotripsy and double J catheter drainage, the renal colic persisted. The laboratory study disclosed abnormally high calcium and parathyroid hormone levels in the blood. A computed tomography (CT) scan of the chest showed a soft tissue nodule located at the aorto-pulmonary window. Technetium-99m-sestamibi scintigraphy demonstrated significantly increased radioactivity before the tracheal carina. The mediastinal parathyroid adenoma was diagnosed and the tumor was removed smoothly with a left-side thoracotomy. After operation, both blood calcium and parathyroid hormone (PTH) levels were back to normal. We present this successfully treated case and discuss how to precisely locate and approach a parathyroid adenoma descending into the mediastium.

並列關鍵字

Parathyroid adenoma ； Technetium-99m-sestamibi scintigraphy ； Thoracotomy