副甲狀腺瘤-導致經常性復發之腎結石之一罕見原因
鍾慧明、許智宏1、吳哲民2
基督教花蓮門諾會醫院泌尿科 1外科 2放射科
Parathyroid adenoma-a rare cause of recurrent nephrolithiasis
Hui-Ming Chung, Tsi-Hong Shu1, Tser-Min Wu2
Department of Urology, Department of Surgery1, and department of Radiology2,
Mennonite Christian Hospital, Hualien, Taiwan
Nephrolithiasis is a common disease, and recurrent nephrolithiasis can cause a significant financial impact on the patients as well as the community. Parathyroid adenoma is a rare cause of nephrolithiasis because it is not a common disease. The possibility of parathyroid adenoma is therefore often overlooked in patients with nephrolithiasis. The authors presented a case of recurrent nephrolithiasis caused by an occult parathyroid adenoma to remind urologists of this rare disease entity that can lead to recurrent nephrolithiasis.
A 62 years old female had suffered from recurrent nephrolithiasis and urinary tract infection during the past decades before she visited our clinic. She had received numerous sessions of treatments, including extracorporeal shock wave lithotripsy, ureteroscopic lithotripsy and percutaneous nephrolithotripsy for recurrent nephrolithiasis of both kidneys over the past ten years. The laboratory test revealed increased level of parathyroid hormone, hypercalcemia and decreased phosphorous levels. Ultrasound examination of the neck, parathyroid CT, and Technetium99m-Sestamibi scintigraphy confirmed the presence of an occult parathyroid adenoma.
The patient was then subjected to surgical excision of the parathyroid adenoma. The postoperative recovery was uneventful. Normalization of parathyroid hormone and calcium levels after surgery was achieved. She is stable at 2 years follow-up with no clinically significant recurrent nephrolithiasis. The authors recommend that systematic etiological work-up for hyperparathyroidism is indicated for all patients with recurrent nephrolithiasis.