The case shared: always cheerful, walking like a fly, loud voice Liu ama has been saying for the past half month that the whole body is weak, achy, memory loss, nausea, even blood pressure has become high, the children at first thought that menopause caused trouble, but Liu ama has been nagging, see people become wilted. The company’s main business is to provide a wide range of products and services to its customers.
Hypercalcemia refers to an abnormal increase in serum ionized calcium concentration. Usually, blood calcium is clinically measured as total plasma calcium, and >2.7 mmol/L is considered hypercalcemia. It is generally considered that hypercalcemia crisis can occur when serum calcium is above 3.75 mmol/L. Improper treatment is a clinical emergency, and hypercalcemia crisis can occur, such as severe dehydration, hyperthermia, cardiac rhythm disturbance, unconsciousness, etc. Patients are prone to die from cardiac arrest, necrotizing pancreatitis and renal failure. Hypercalcemia is mainly seen in hyperparathyroidism, followed by tumor and overdose of vitamin D. Symptoms include weight loss, general muscle weakness, headache, insomnia, loss of appetite, nausea, thirst, excessive drinking, polyuria, etc. Many malignant tumors can be complicated by hypercalcemia. Many malignant tumors can be complicated by hypercalcemia.
The doctor quickly brainstormed the possible causes of hypercalcemia and suggested the patient to check parathyroid hormone, the result was super high parathyroid hormone: 1731.48 pg/ml. examination of neck thyroid ultrasound suggested a 3*4 cm mass in the right posterior lower thyroid gland, considering thyroid or parathyroid occupancy, technetium 99 duplex nuclear examination suggested a mixed mass in the right posterior lower thyroid lobe MIBI diachronic imaging A positive MIBI diachronic image was obtained. The patient’s preliminary diagnosis based on the findings and history: primary right-sided hyperparathyroidism.
The average person has four parathyroid glands posterior to the thyroid gland, with two glands superior and inferior on each side, left and right. Normal parathyroid glands are of various shapes, about the size of a green bean, and weigh an average of 35 to 40 mg.
The parathyroid glands secrete thyroxine (PTH) which has the following effects.
1. promoting calcium reabsorption by the proximal renal tubule, resulting in a decrease in urinary calcium and an increase in blood calcium.
2. inhibiting the absorption of phosphorus by the proximal renal tubule, resulting in an increase in urinary phosphorus and a decrease in blood phosphorus.
3.Promote the decalcification of osteoclasts and increase the concentration of blood calcium and blood phosphorus.
4.Promote the hydroxylation of vitamin D to produce active 1,25 dihydroxy D3, the latter promotes the absorption of calcium from food in the intestine. The above actions maintain blood calcium in normal individuals in the normal range.
What is the most effective way to treat hypercalcemia, which is potentially life-threatening?
The main causes of hyperparathyroidism are hyperplasia, adenoma, and cancer. There are of course other causes. The patient has no history of renal disease or kidney transplantation directly excluding secondary hyperparathyroidism and triple hyperparathyroidism, no breast tumors or bone metastases, and no evidence of multiple endocrine tumors. The surgeon’s mission is to remove the abnormal tissue to treat the disease in the most direct and elegant way: surgically removing the cause and removing the parathyroid adenoma to treat the disease. The patient underwent excision of the right parathyroid adenoma under general anesthesia. The operation went well and the hypercalcemia was normalized 3 days after the operation and the parathyroid hormone was normalized. The patient’s above symptoms improved.
It turns out that general weakness, muscle pain and high blood pressure may also be due to hyperparathyroidism caused by parathyroid adenoma. It is more common in people between 20 and 50 years old, and more women than men. The onset of hyperparathyroidism is slow, with the first kidney stone, bone pain as the main manifestation, high blood calcium and neurological syndrome, or no symptoms at all. The disease is relatively uncommon.
The clinical manifestations can be grouped into the following four groups.
Hypercalcemia and hypophosphatemia are early symptoms that are often overlooked.
1, digestive system, may have symptoms such as lack of appetite, constipation, abdominal distension, nausea, vomiting.
2, muscle limb muscle relaxation, hypotonia, patients are easy to fatigue and weakness.
3, urinary system, due to high blood calcium, resulting in excessive calcium excretion from the urine, the patient often complains of polyuria, thirst, excessive drinking, urinary stones.
4, skeletal symptoms, initial bone pain, which may be located in the back, spine, hip, thoracic ribs or extremities, accompanied by pressure pain.
5, other symptoms, some patients with psychiatric symptoms are common, mainly depression-like manifestations: depressed mood, fatigue, lack of initiative and irritability, etc., may also appear memory loss and slow thinking.
It turns out that fatigue, weakness and muscle aches can also be parathyroid adenoma, which is so scary. In retrospect, it is true that parathyroid adenomas are easily overlooked and are only seen when parathyroid crisis occurs, and some patients may die without being seen. Therefore, patients are reminded that timely consultation or health checkups if they are unwell can promptly detect many diseases under hiding. The diagnosis of the patient in this case revealed that there are sets everywhere and diseases are missed if you are not careful.