- 期刊
Urolithiasis and Primary Parathyroid Adenoma: Report of One Case
孩童腎結石及副甲狀腺瘤：一病例報告
摘要
十二歲的女童因血尿，左側腰痛而至本院急診就診，診斷爲急性腎盂炎，給予抗生素治療無效，再次至門診就醫，腹部超音波掃瞄發現在腎盂輸尿管交接處有塊結石，於是安排住院探查腎結石的成因處置。住院的實驗室檢查有高血鈣、低血磷、高尿鈣，正常鹼性磷酸酶及偏高的副甲狀腺素值等現象。經過體外碎石術成功地把結石處理後，病人的症狀迅速改善。後續探究副甲狀腺高能症的檢查發現，核醫掃瞄在左甲狀腺下方有放射線聚積；高解相超音波檢查找到一粒1.4×1.47×0.9公分大的結節，於是在副甲狀腺瘤的臆斷下由小兒外科醫師切除，病理切片證實為副甲狀腺瘤。 孩童腎結石並不是普遍的疾病，一旦發生了，必須努力探查其成因，以防再度復發。副甲狀腺高能症是產生腎結石重要的原因之一，也少見於孩童時期。血清鈣、磷、鹼性磷酸酶及尿鈣的測定是必要的檢查。有高血鈣及偏高的副甲狀腺素值時，必須攷量副甲狀腺高能症。
並列摘要
A 12-year-old girl was admitted to ward because of persistent left flank pain, vomiting, and hematuria. A stone was located at the ureteropelvic junction of the left kidney, as determined by means of abdominal sonography. Metabolic investigation for a renal stone revealed that she had hypercalcemia, hypophosphatemia, and hypercalciuria. Hyperparathyroidism was diagnosed based on the hype rcalcemia and inappropriately elevated serum parathyroid hormone level. A parathyroid adenoma was successfully diagnosed by using thallium/technetium subtraction parathyroid scanning. Extracorporeal shock wave lithotripsy was performed to treat the renal stone, and the parathyroid adenoma was successfully removed. The patient’s postoperative course was uneventful. This case is presented because urolithiasis and hyperparathyroidism are rare in children. Metabolic evaluation is mandatory in children with a renal stone. Further investigation for the hyperparathyroidism should be performed if hypercalcemia associated with hypercalciuria is documented.
延伸閱讀
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