原発性副甲状腺機能亢進症23例の臨床的検討

Abstract

過去17年間に経験した本症23例について, 1)病型分類では, 腎型15例, 化学型6例, 骨型およびcrisis型が各1例であった.2)術前生化学的諸検査の中で, 血清Ca値は, 最も異常値を示す頻度が高く, 各症例の平均値では23例中21例, 及び測定された全検体中87.8%で高値を示した.ついで, 血清Ca++及びP値も高頻度で異常値を示した.また, 血清PTHによる診断率は, 18例中12例であった.3)術前部位診断成績のうち, 201Tl-chlorideを用いた副甲状腺シンチグラフィでは10例中8例, また, CTでは15例中10例で部位診断が可能であった

Twenty-three cases of primary hyperparathyroidism were experienced at Wakayama Medical College Hospital and affiliated hospitals between January, 1969 and December 1985. Histopathological findings were adenoma in 22 cases, hyperplasia in 1 case. On the clinical diagnosis of this disease, the most sensitive laboratory test was serum calcium level, which was elevated in 21 patients (91%), and in 87.8% of all samples measured. Serum ionized calcium and phosphorus were also sensitive measures. The positive rate of serum PTH was 67% in 18 cases. Tl-chloride scintigraphy identified preoperatively the site of the adenomas in 8 out of 10 cases, and computed tomography in 10 out of 15 cases. Both methods are non-invasive, and are beneficial for the preoperative examination of the localization of parathyroid adenoma. After parathyroidectomy, serum calcium and ionized calcium levels recovered rapidly within the normal limit in 12 hours. On the other hand, serum phosphorus level increased gradually up to the normal limit in about 1 week.