影像學陰性之原發性副甲狀腺機能亢進症：病例報告與文獻回顧

Image Negative Hyperparathyroidism: A Case Report and Literature Review

徐維信(Wei-Hsin Hsu) ； 黃士銘(Shih-Ming Huang) ； 楊麗瓊(Lai-King Yu) ； 吳達仁(Ta-Jen Wu)

《內科學誌》 21卷3期 (2010/06) Pp. 216-221

https://doi.org/10.6314/JIMT.2010.21(3).09

摘要

原發性副甲狀腺機能亢進症經常以輕微症狀或無特殊症狀來表現，後者稱爲無症狀性原發性副甲狀腺機能亢進症。原發性副甲狀腺機能亢進症主要症狀是來自於慢性高血鈣，在完整性副甲狀腺素偏高，且又排除鋰鹽或利尿劑藥物使用及家族性低尿鈣性高血鈣症情況下，即可診斷原發性副甲狀腺機能亢進症。術前影像學可以先行定位可疑之副甲狀腺病灶。今報告一術前影像學陰性病例：病人爲64歲男性，因常規檢查發現腎功能惡化，高鈣血症(Ca(上标 ++):11.5mg/dL)及完整性副甲狀腺素(intact PTH: 145pg/mL)上升而求診。在排除家族性低尿鈣性高血鈣症(FHH)後，安排頸部超音波及副甲狀腺核子醫學掃瞄術前定位，在頸部及縱膈腔均未發現任何副甲狀腺腫瘤。後來經施行雙側頸部廣泛性探查手術，在左側下方部位切除一顆重量僅140毫克(mg)之副甲狀腺腫瘤。經病理檢驗證實爲副甲狀腺之細胞增生病灶。手術後15分鐘，血清完整性副甲狀腺素由術前115pg/mL降低爲16 pg/mL，血鈣於手術後第三天降至正常範圍9.9mg/dL。臨床上副甲狀腺腫瘤之影像學定位偶爾呈現陰性，可能的原因有：異位性副甲狀腺腫瘤、副甲狀腺腺瘤太小、副甲狀腺素輕微偏高、雙副甲狀腺腺瘤、及副甲狀腺增生等。術前影像學呈現陰性之原發性副甲狀腺機能亢進症宜採用雙側頸部探查手術，因此應將患者轉介至熟悉此種手術之外科專科醫師。

關鍵字

副甲狀腺機能亢進症 ； 影像學陰性 ； 副甲狀腺掃瞄 ； Sestamibi scan

並列摘要

Most cases of primary hyperparathyroidism are asymptomatic. Symptomatic cases are caused by chronic hypercalcemia. Hypercalcemia with high intact parathyroid hormone are major clues to the diagnosis of primary hyperparathyroidism. Preoperative image studies to localize parathyroid lesion are helpful for decision making of surgical intervention. However, cases with image negative hyperparathyroidism are not unusual in clinical practice. We report a case which is primary hyperparathyroidism with negative imaging study. This 64-year-old male patient came for renal function deterioration and hypercalcemia and high intact parathyroid hormone (PTH). After excluding familial hypocalciuric hypercalcemia at first. Neck sonogram and parathyroid sestamibi scan were arranged for pre-operation localization which showed negative. Bilateral neck exploratory surgery was arranged. A left lower parathyroid tumor weighting 140 mg was excised. Fifteen minutes after excision of tumor, intact PTH decreased from preoperative value of 115pg/mL to 16pg/mL. Three days later, serum calcium decreased to 9.9mg/dL. The factors related to negative imaging include ectopic parathyroid tumor, small size of parathyroid adenoma, mild elevation of parathyroid hormone, double tumors, and parathyroid hyperplasia. As extensive bilateral neck exploration is indicated for the cases with image negative hyperparathyroidism, these patients should be referred to surgical experts for such procedure.

並列關鍵字

Hyperparathyroidism ； Image-negative ； Parathyroid scan ； Sestamibi scan