副甲状腺亜全摘除術が著効した二次性副甲状腺機能亢進症に伴う巨大異所性石灰化の1例

Abstract

54歳女.患者は慢性糸球体腎炎による慢性腎不全のため血液透析が導入されていた.今回, 左大腿部・左踵骨部異所性石灰化に対し切除術が施行され, 左肩関節には鳩卵大の, 左大転子には小児頭大, 更に左外果周囲には鶏卵大に突出する弾性硬の皮下腫瘤が触知できた.また, 左外果には皮膚潰瘍を認め, 圧痛を伴う部位もあった.左大転子部腫瘤性石灰化のため, 運動可動域の制限・疼痛があり, 歩行不可能であった.二次性副甲状腺機能亢進症に伴う腫瘤性石灰化と判断し, 全身麻酔下に副甲状腺を摘除し, 副甲状腺亜全摘除術とした.その結果, 腫瘤性石灰化は術後3ヵ月より徐々に改善傾向を示し, 術後10ヵ月現在, 著明に縮小し短時間であるが独歩可能となった

A 54-year-old woman was referred to our hospital for the treatment of secondary hyperparathyroidism due to chronic renal failure. She was on hemodialysis for 7 years and suffered from giant tumor calcinosis of the major joints associated with severe hypercalcemia and hyperphosphatemia. The largest one of the left hip joint caused gait disturbance. Medical therapy was unsuccessful and she underwent subtotal parathyroidectomy. After the operation, although the levels of serum calcium and phosphate were not normalized, the level of parathyroid hormone was lowered to the normal range. The volume of the tumor calcinosis gradually reduced and she became able to walk for a short distance 10 months after the operation.