2025年 · 第40卷第10期

A 33-year-old male was admitted to the emergency department with "upper abdominal pain for 2 d". Physical examination: soft abdomen, positive upper abdominal tenderness. Laboratory tests: serum amylase: 237.9 U/L, urinary amylase: 530.6 U/L, serum calcium: 3.51 mmol/L, serum alkaline phosphatase: 916.3 U/L. Abdominal CT examination showed exudation around the head of the pancreas and around the gastric antrum-duodenum, which was considered to be caused by pancreatitis. Initial diagnosis: hypercalcemia (severe), acute pancreatitis. After hypocalcification treatment, the serum calcium was re-examined: 3.66 mmol/L, and transferred to ICU for continuous renal replacement therapy. The serum parathyroid hormone PTH was 2 259.00 pg/mL, and the neck color ultrasound examination showed a mixed echo mass at the inferior pole of the left lobe of the thyroid gland, except for the parathyroid source. Parathyroid radionuclide imaging showed that nodules at the lower pole of the left lobe of the thyroid gland considered parathyroid adenoma. CT examination of the neck showed space-occupying lesions in the left lobe of the thyroid gland and tracheal compression. After multidisciplinary consultation, the diagnosis was: primary hyperparathyroidism, parathyroid tumor, hypercalcemia (severe), acute pancreatitis. Excision of left lower pole parathyroid tumor was performed. During the operation, the boundary between the tumor and the anterior cervical band muscle, thyroid gland and central lymph node was unclear (Figure 1), and ipsilateral thyroidectomy and central lymph node dissection were performed. Multiple internal hemorrhagic necrosis was seen in the incised tumor specimen (Figure 2). The pathological findings were parathyroid carcinoma (PC) (Figure 3). On the first postoperative day, serum calcium was 2.37 mmol/L, serum PTH was 11.96 PG/ml, blood amylase was 128.10 U/L, and urinary amylase was 154.70 U/L. The patient's serum PTH and blood calcium were normal after reexamination 7 months after operation, and there was no sign of recurrence.

A 25-year-old woman was admitted to the hospital on 12-Jul-2024 due to "26 weeks of menopause and 1 d of apathy". The neck examination showed no abnormalities. Laboratory tests: blood calcium 3.55 mmol/L (normal value: 2.11~2.52 mmol/L), blood phosphorus 0.51 mmol/L (normal value: 0.85~1.51 mmol/L), parathyroid hormone (PTH) 497 pg/ml (normal value: 15~75 pg/ml). Color parathyroid ultrasound revealed a hypoechoic mass in the lower right parathyroid region, about 2.1×1.6 cm in size. After multidisciplinary consultation, she was diagnosed as pregnancy complicated with primary hyperparathyroidism (PHPT), hypercalcemia, and right kidney stones. Considering that severe hypercalcemia affects the health of mother, fetus and newborn, it is necessary to actively reduce blood calcium and perform surgery as soon as possible. After volume expansion and fluid rehydration, furosemide diuresis, the blood calcium decreased to 3.31 mmol/L, and the right lower parathyroidectomy was performed on July 15, 2024. The intraoperative and postoperative pathological examinations were consistent with parathyroid adenoma. Transient hypoparathyroidism occurred after operation, and calcium supplementation and vitamin D were given. After half a month after operation, blood calcium and PTH returned to normal. The patient suffered from acute abdominal pain due to right kidney stone 3 months after delivery. He underwent lithotripsy in a local hospital and recovered well after operation.