以消化道症状为首发表现的原发性甲状旁腺功能亢进症1例

A Case of Primary Hyperparathyroidism Presenting with Gastrointestinal Symptoms as the Initial Manifestation

摘要: 目的：探讨以消化道症状为首发表现的原发性甲状旁腺功能亢进症(Primary Hyperparathyroidism, PHPT)的临床特征、诊断及治疗策略，以期减少临床漏诊误诊。方法：回顾性分析济宁市第一人民医院内分泌科收治的1例以消化道症状为主要表现的PHPT患者临床资料，结合相关检查明确诊断。结果：实验室检查显示高血钙、低血磷、显著升高的血清甲状旁腺激素(Parathyroid Hormone, PTH)，影像学提示甲状腺左叶外侧MIBI显像阳性，甲状旁腺腺瘤可能，病理证实为甲状旁腺腺瘤，患者行甲状旁腺腺瘤切除术后，血钙及PTH恢复正常，消化道症状消失。结论：PHPT多表现为骨质疏松、病理性骨折、尿路结石、乏力等，首发表现为消化道症状的患者少见，易被误诊为胃肠道疾病，临床上遇到不明原因的消化道症状伴高钙血症时，需要警惕PHPT的发生，及时检测血钙及PTH的水平，结合影像学检查，尽早进行手术干预，改善患者的症状及预后。

Abstract: Objective: To explore the clinical features, diagnosis and treatment strategies of Primary Hyperparathyroidism (PHPT) presenting with gastrointestinal symptoms as the initial manifestation, in order to reduce the rate of missed and misdiagnosis in clinical practice. Methods: The clinical data of a PHPT patient with gastrointestinal symptoms as the main manifestation admitted to the Department of Endocrinology of Jining No. 1 People’s Hospital were retrospectively analyzed. The diagnosis was confirmed by relevant examinations. Results: Laboratory tests showed hypercalcemia, hypophosphatemia, and significantly elevated serum Parathyroid Hormone (PTH). Imaging studies indicated a positive MIBI scan in the lateral part of the left lobe of the thyroid, suggesting a possible parathyroid adenoma. Pathology confirmed a parathyroid adenoma. After parathyroid adenoma resection, the patient’s blood calcium and PTH levels returned to normal, and gastrointestinal symptoms disappeared. Conclusion: PHPT is often characterized by osteoporosis, pathological fractures, urinary calculi, and fatigue. Patients presenting with gastrointestinal symptoms as the initial manifestation are rare and are easily misdiagnosed as gastrointestinal diseases. When encountering unexplained gastrointestinal symptoms accompanied by hypercalcemia in clinical practice, PHPT should be suspected, and blood calcium and PTH levels should be promptly measured. Combined with imaging examinations, surgical intervention should be performed as soon as possible to improve the patient’s symptoms and prognosis.