小结
定义
病史和体格检查
关键诊断因素
- 甲状腺、甲状旁腺或喉部手术史
- 慢性酒精中毒
- 营养不良、吸收不良、腹泻
- 肌肉颤搐、痉挛、痛性痉挛
- 感觉异常、麻木、麻刺感
- 记忆力差、思维缓慢
- 低钙击面征
- 惊厥
- 心脏搏动不规则、心动过速
- 低钙束臂征
其他诊断因素
- 焦虑
- 毛发干枯、脆甲症
- 白内障
- 黏膜皮肤念珠菌病病史
- 地中海贫血患者长期输血史
- 呼吸困难
- 喉痉挛
危险因素
- 甲状腺手术
- 甲状旁腺手术
- 低镁血症
- 中度和慢性母体高钙血症（新生儿低钙血症）
- 常染色体显性遗传（例如，CASR、GATA3 突变）
- 遗传性血色病
- 地中海贫血治疗中输注了超负荷的铁
- Wilson 病（肝豆状核变性）
- 转移性癌
诊断性检查
首要检查
- 血清钙
- 血清白蛋白
- 心电图 (ECG)
- 血浆全段 PTH
- 血清镁
- 血清 25 -羟基维生素 D
- 血清磷
- 血清肌酐
需考虑的检查
- 24-小时尿钙、肌酐
- 24-小时镁、肌酐
- 肝功能检查
- 动脉血气 (ABG) 分析
- 血清游离甲状腺素、促甲状腺素
- 晨起皮质醇和促肾上腺皮质激素 (ACTH) 刺激试验
- 全血细胞计数
- 血清铁、转铁蛋白、铁蛋白
- 血清铜
- 眼科检查
- 听力学
- 肾脏影像学检查
- 基因测序
新兴检查
- 21-羟化酶或 1 型干扰素自身抗体
治疗流程
重度症状性低钙血症（白蛋白校正血清总钙量＜1.88 mmol [＜7.5 mg/dL]）
无症状性术后暂时性低钙血症
慢性甲状旁腺功能减退症
撰稿人
作者
Dolores Shoback, MD
Professor of Medicine
University of California San Francisco
Endocrine Research Unit
San Francisco VA Medical Center
San Francisco
CA
利益声明
DS worked as a consultant for Takeda Pharmaceuticals, Ascendis, and Bridge Bio. She has received honorarium from Neopharma, and served as an expert witness for a patient-based malpractice case. For the past 5 years, DS was a speaker for the annual patients and caregivers conference on hypoparathyroidism for the US-based Hypoparathyroidism Association, and is an unpaid member of their medical advisory board. DS has given many CME lectures on hypoparathyroidism and calcium and bone and mineral disorders.
Quan-Yang Duh, MD
Professor of Surgery
Section of Endocrine Surgery
University of California San Francisco
San Francisco
CA
利益声明
QYD declares that he has no competing interests.
鸣谢
Professors Dolores Shoback and Quan-Yang Duh would like to gratefully acknowledge Professor Ronald Merrell, a previous contributor to this topic. RM declares that he has no competing interests.
同行评议者
Wail Malaty, MD
Adjunct Clinical Professor
Department of Family Medicine
University of North Carolina
Chapel Hill
NC
利益声明
WM declares that he has no competing interests.
鉴别诊断
- 维生素 D 缺乏症
- 低镁血症
- 低白蛋白血症
更多 鉴别诊断指南
- 成人甲状旁腺功能减退症的诊疗标准：加拿大和国际共识
- 成人术后甲状旁腺功能减退症：诊断、预防和管理
更多 指南
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