以腹痛为首发症状的甲状旁腺腺瘤1例并文献复习

Parathyroid Adenoma Presenting with Abdominal Pain as the Initial Symptom: A Case Report and Literature Review

摘要: 目的：加深对甲状旁腺腺瘤并急性胰腺炎并双肾结石的认识，从而减少漏诊率，防止不良并发症。方法：回顾性分析患者基本资料、临床表现、生化指标、影像学资料及治疗转归，结合国内外相关文献讨论甲状旁腺腺瘤的诊治经验。结果：患者住院期间发现高钙血症和低磷血症，最终通过甲状旁腺超声和核素显像诊断为甲状旁腺腺瘤所致的原发性甲状旁腺功能亢进。手术治疗后症状好转，术后病理确诊为甲状旁腺腺瘤。结论：原发性甲状旁腺功能亢进临床表现多样，以腹痛(如胰腺炎、肾结石)为首发症状时易漏诊。对于急性胰腺炎合并高钙血症患者，即使甲状旁腺素早期正常，仍需动态监测，避免漏诊原发性甲状旁腺功能亢进。

Abstract: Objective: This case report aims to enhance the understanding of parathyroid adenoma associated with acute pancreatitis and bilateral renal stones, in order to reduce the misdiagnosis rate and prevent the occurrence of adverse complications. Methods: A retrospective analysis was conducted on the patient’s demographic information, clinical presentation, biochemical markers, imaging findings, and therapeutic outcomes. Relevant literature, both domestic and international, was reviewed to discuss the diagnostic approaches and treatment strategies for parathyroid adenoma. Results: During the patient’s hospitalization, hypercalcemia and hypophosphatemia were detected, ultimately leading to a diagnosis of primary hyperparathyroidism caused by parathyroid adenoma, confirmed through parathyroid ultrasound and scintigraphy. Following surgical intervention, the patient’s symptoms improved, and postoperative pathology confirmed the diagnosis of parathyroid adenoma. Conclusion: Primary hyperparathyroidism (PHPT) presents with a wide range of clinical manifestations, and when abdominal pain (such as that seen in pancreatitis or renal stones) is the initial symptom, it is often misdiagnosed. In patients with acute pancreatitis complicated by hypercalcemia, even if parathyroid hormone (PTH) levels are initially normal, dynamic monitoring of PTH is necessary to avoid missing the diagnosis of primary hyperparathyroidism.