初级甲状腺功能障碍症与多发性硬化症重叠:一场灾难性的婚姻
Gianfranco Cervellin1, Vincenzo Brianti2, Lorenzo Viani3
1University Hospital of Parma, Italy. gianfranco.cervellin@gmail.com.
Acta bio-medica : Atenei Parmensis
|July 24, 2023
概括
原发性偏甲状腺症 (PHPT) 可以模仿神经疾病. 这个案例突出了一个患者的症状恶化是由于严重的PHPT而不是多发性硬化症 (MS),强调了代谢评估的必要性.
科学领域:
- 内分泌学 在内分泌学.
- 神经学 神经学
- 老年病的医生 老年病的医生
背景情况:
- 原发性偏甲状腺症 (PHPT) 是一种常见的内分泌疾病.
- PHPT可以呈现出各种神经和精神症状,往往导致误诊.
- 同时出现PHPT和先前存在的神经疾病,如多发性硬化症 (MS) 可以使诊断复杂化.
研究的目的:
- 报告一种独特的严重PHPT病例,模仿了先前存在的多发性硬化症 (MS) 的恶化.
- 强调在患有无法解释的神经或精神疾病恶化的患者中考虑代谢障碍的重要性.
- 突出PHPT的成功手术管理及其对患者康复的影响.
主要方法:
- 一个77岁的男性病例报告显示,他表现为疲劳,跌倒,恶心,厌食症和便秘.
- 诊断工作包括实验室测试,和副甲状腺激素 (PTH) 水平.
- 部计算机断层扫描 (CT) 发现了副甲状腺质量;手术切除证实了副甲状腺腺瘤.
主要成果:
- 患者出现严重的高血症 (16.8 mg/dL) 和升高的PTH (508 pg/mL),表明PHPT.
- 通过手术切除甲状腺腺瘤,导致症状完全消失,酸代谢正常化.
- 手术后也注意到糖尿病控制的改善,允许减少甲福明的剂量.
结论:
- 这一案例代表了第一个在轻微的,长期存在的MS和未被识别的严重PHPT之间存在重大症状重叠的记录实例.
- 对于经历神经肌肉或神经精神症状恶化的患者来说,无论先前的诊断如何,全面的代谢评估至关重要.
- 及时诊断和治疗PHPT可以导致显著的临床改善,并防止错误地将症状归因于其他疾病.
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