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Hiperparatiroidismo primário : caso clínico e revisão da literatura
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O hiperparatiroidismo primário, apesar de ser uma doença endócrina comum na 6ª e 7ª décadas de vida, é correntemente uma patologia com baixo impacto a nível de manifestações clínicas, uma vez que é maioritariamente diagnosticada na fase assintomática. O caso clínico ilustrativo que se segue, representa uma apresentação hoje em dia rara, cujos sintomas não foram valorizados pelos clínicos assistentes durante vários anos. Doente do sexo feminino de 73 anos, com antecedentes de hipertensão arterial (HTA), diabetes mellitus tipo 2 (DM2), glomerulonefrite, litíase renal, doença de refluxo gastro-esofágico (DRGE) e osteoartrose. Referenciada à consulta de Medicina Interna por tumefação periorbitária externa, de crescimento progressivo, com cerca de 10 anos de evolução que dificultava o uso de óculos, motivada por um foco de osteíte fibrosa quística na asa direita do esfenóide. Desde essa altura referia também queixas de dores ósseas generalizadas, palpitações, irritabilidade, humor depressivo, astenia e mal-estar geral. Da investigação destaca-se uma hipercalcémia com elevação da hormona paratiroideia (PTH) que, após exclusão de causas secundárias, confirmou a presença de hiperparatiroidismo primário (HPP). Foi detectado um adenoma paratiroideu por tomografia computorizada e confirmado por cintigrafia das paratiroideias, com melhoria dos parâmetros laboratoriais e clínicos, após adenectomia paratiroideia. Trata-se de uma apresentação pouco comum no contexto actual, em que cerca de 80% dos diagnósticos se fazem em doentes assintomáticos, apenas com hipercalcémia detectada em análises de rotina. Em doentes sintomáticos, os sinais e sintomas podem ser muito variados, e a doença afectar múltiplos órgãos e sistemas. O adenoma da paratiroide é responsável pela grande maioria dos casos de HPP, sendo o tratamento mais adequado a sua excisão, caso seja possível. Foi realizada uma revisão da literatura atual acerca desta patologia.
Primary hyperparathyroidism, although it is a common endocrine disorder in the 6th and 7th decade of life, is a condition with mild clinical manifestations, since it is mainly diagnosed in the asymptomatic phase. The illustrative clinical case that follows is a rare presentation nowadays, which was not recognized by her doctors for several years. 73 year-old woman, with a past history of hypertension, diabetes mellitus type 2 (DM2), glomerulonephritis, urolithiasis, gastro-oesophageal reflux disease (GERD) and osteoarthritis. She was referred to the Internal Medicine outpatient department due to periorbital swelling wich makes dificcult the use of glasses, that had slowly developed for about 10 years, caused by a focus of osteitis fibrosa cystica on the right wing of the sphenoid bone. She also complained of generalized bone pain, palpitations, irritability, depressed mood, asthenia and malaise. Laboratory tests revealed hypercalcemia and elevated parathyroid hormone (PTH) which, after excluding secondary causes, confirmed the presence of primary hyperparathyroidism (PHP). A CT scan and scintigraphy of the parathyroid revealed the presence of a parathyroid adenoma. The patient underwent surgery to remove the adenoma, after which laboratory and clinical parameters were shown to have improved. Nowadays, the former is considered an unusual presentation of the disease, as about 80% of patients first present with no symptoms, with only elevated serum calcium detected in routine blood tests. Symptomatic patients can present with a wide variety of signs and symptoms and the disease can affect multiple organs. Parathyroid adenoma is responsible for the majority of PHP cases, the most appropriate treatment is to remove it. A review of current literature on this pathology was performed.
Primary hyperparathyroidism, although it is a common endocrine disorder in the 6th and 7th decade of life, is a condition with mild clinical manifestations, since it is mainly diagnosed in the asymptomatic phase. The illustrative clinical case that follows is a rare presentation nowadays, which was not recognized by her doctors for several years. 73 year-old woman, with a past history of hypertension, diabetes mellitus type 2 (DM2), glomerulonephritis, urolithiasis, gastro-oesophageal reflux disease (GERD) and osteoarthritis. She was referred to the Internal Medicine outpatient department due to periorbital swelling wich makes dificcult the use of glasses, that had slowly developed for about 10 years, caused by a focus of osteitis fibrosa cystica on the right wing of the sphenoid bone. She also complained of generalized bone pain, palpitations, irritability, depressed mood, asthenia and malaise. Laboratory tests revealed hypercalcemia and elevated parathyroid hormone (PTH) which, after excluding secondary causes, confirmed the presence of primary hyperparathyroidism (PHP). A CT scan and scintigraphy of the parathyroid revealed the presence of a parathyroid adenoma. The patient underwent surgery to remove the adenoma, after which laboratory and clinical parameters were shown to have improved. Nowadays, the former is considered an unusual presentation of the disease, as about 80% of patients first present with no symptoms, with only elevated serum calcium detected in routine blood tests. Symptomatic patients can present with a wide variety of signs and symptoms and the disease can affect multiple organs. Parathyroid adenoma is responsible for the majority of PHP cases, the most appropriate treatment is to remove it. A review of current literature on this pathology was performed.
Descrição
Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2016
Palavras-chave
Hiperparatireoidismo primário Idoso