小结
定义
病史和体格检查
关键诊断因素
- 生化检查时偶然发现
- 骨质疏松症或骨量减少病史
- 甲状旁腺功能亢进症家族史或可提示高钙血症的特征表现
- 肾结石
其他诊断因素
- 睡眠质量差
- 疲劳
- 肌痛
- 焦虑
- 抑郁症
- 记忆减退
- 明显的神经肌肉功能障碍
- 心血管和代谢功能障碍
- 提示高钙血症的特征
- 坚硬而紧实的颈部肿块
危险因素
- 女性
- 年龄 ≥ 50-60 岁
- PHPT 家族史
- 多发性内分泌腺瘤 (MEN) 1 型、2A 型或 4 型
- 目前或既往的锂治疗
- 甲状旁腺功能亢进症-颌骨肿瘤综合征
- 头颈部放射史
诊断性检查
首要检查
- 血清钙
- 使用免疫放射方法或免疫化学方法检测血清全段 PTH。
需考虑的检查
- 25-羟基维生素 D 水平
- 血清碱性磷酸酶
- 血清磷
- 24 小时尿钙
- 双能 X 线骨密度测量仪 (DXA) 扫描
- 骨小梁评分
- Tc-99 甲氧基异丁基异腈扫描和超声检查
- 单光子发射 CT+ 甲氧基异丁基异腈扫描
- 颈部 CT 扫描
- 颈部 4 维 (4D) CT
- 颈部 MRI 扫描
新兴检查
- 放射性标记胆碱 PET
治疗流程
无症状但有手术指征，或者有症状
无症状也无手术指征
撰稿人
作者
John Ayuk, MD
Consultant Endocrinologist
University Hospitals Birmingham
Birmingham
UK
利益声明
JA declares that he has no competing interests.
Neil Gittoes, MD, PhD
Consultant Endocrinologist and Honorary Professor of Endocrinology
Associate Medical Director
University Hospitals Birmingham
Birmingham
UK
利益声明
NG has contributed to advisory boards for Takedo and Shire pharmaceuticals.
鸣谢
Dr John Ayuk and Professor Neil Gittoes would like to gratefully acknowledge Dr Fausto Palazzo, Dr Swaroop Gantela, and Dr Nancy D. Perrier, the previous contributors to this topic. FP, SG, and NDP declare that they have no competing interests.
同行评议者
Bridget Sinnott, MD
Clinical Assistant
Professor of Medicine
University of Illinois at Chicago
Chicago
IL
利益声明
BS declares that she has no competing interests.
Udaya Kabadi, MD
Professor of Medicine
Department of Internal Medicine
University of Iowa
Iowa City
IA
利益声明
UK declares that she has no competing interests.
Leonard Egede, MD
Professor of Medicine
Medical University of South Carolina
Charleston
SC
利益声明
LE declares that he has no competing interests.
Petros Perros, BSc, MBBS, MD, FRCP
Department of Endocrinology
Elliott Building
Royal Victoria Infirmary
Newcastle-upon-Tyne
UK
利益声明
PP declares that he has no competing interests.
鉴别诊断
- 家族性低尿钙性高钙血症 (FHH)
- 恶性肿瘤体液性高钙血症
- 多发性骨髓瘤
更多 鉴别诊断指南
- EANM 甲状旁腺成像实践指南
- 甲状旁腺核素显像性能的 ACR-SPR 实践参数
更多 指南
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