一个罕见的原发性甲状旁腺功能亢进症模拟病例

Q3 Medicine

Acute Medicine Pub Date : 2023-01-01

T Wynn, H Marath, A Brahma, V Rajagopal

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引用次数: 0

摘要

一位 32 岁的女士有神经性贪食症病史，她的血钙调整值升高至 2.94mmol/L，甲状旁腺激素（PTH）升高至 17.2pmol/L。复查发现，她患有明显的高钙血症至少已有三年，同时还患有慢性严重碱中毒，碳酸氢盐高达 81.9mEQ/L。在此期间，电离钙实际上一直很低，只有 1.03mmol/L。这个病例突出说明了碱中毒对钙的影响，因为有更多的白蛋白可以与离子钙结合。这就导致离子钙过低，从而引发 PTH 释放，总体上导致调整后的血钙水平升高。临床医生可能会误诊类似的原发性甲状旁腺功能亢进症患者，治疗会导致真正的低钙血症恶化。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

本刊更多论文

An Unusual Case of a Primary Hyperparathyroidism Mimic.

A 32-year-old lady with a history of bulimia nervosa was noted to have a raised adjusted calcium of 2.94mmol/L associated with high parathyroid hormone (PTH) 17.2pmol/L. On review, she had an apparent hypercalcaemia for at least three years, and also had a chronic, severe alkalosis with a bicarbonate up to 81.9mEQ/L. Ionised calcium during that time had actually been low, down to 1.03mmol/L. This case highlights the effects of alkalosis on calcium, as more albumin is available for binding to ionised calcium. This results in a low ionised calcium, which triggers PTH release and overall leads to raised adjusted calcium levels. Clinicians may misdiagnose a similar patient with primary hyperparathyroidism and treatment would cause worsening of true hypocalcaemia.

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来源期刊

Acute Medicine Medicine-Emergency Medicine

CiteScore

1.50

自引率

0.00%

发文量

期刊介绍： These are usually commissioned by the editorial team in accordance with a cycle running over several years. Authors wishing to submit a review relevant to Acute Medicine are advised to contact the editor before writing this. Unsolicited review articles received for consideration may be included if the subject matter is considered of interest to the readership, provided the topic has not already been covered in a recent edition. Review articles are usually 3000-5000 words and may include tables, pictures and other figures as required for the text. Include 3 or 4 ‘key points’ summarising the main teaching messages.