Analysis of 7 Misdiagnosed Cases of Primary Hyperparathyroidism and the Related Literature Review

QIU Ping; TANG Ming-wei; MEI Xi; LAN Tian; LIAO Lu-miu; LI Yao

doi:10.3969/j.issn.1002-3429.2015.08.008

Abstract：Objective To investigate clinical features, misdiagnosed causes and preventive measures of primary hy-perparathyroidism ( PHPT) . Methods The clinical data of seven misdiagnosed cases of PHPT during January 2010 and Jan-uary 2014 in the first affiliated hospital of Chengdu Medical College were analyzed retrospectively. The relevant literature was reviewed. Results All the cases had apparent increased intact parathyroid hormone ( iPTH) complicated with severe osteopo-rosis and were misdiagnosed at the first visit. Four patients were misdiagnosed with lumbar disc herniation, bone cysts, meta-static tumors, or fibrocartilaginous dysplasia respectively in orthopedics department. 1 case was misdiagnosed as coronary heart disease and hypertension in cardiovascular department. 1 case had pure renal calculus and chronic obstructive nephropathy for a long period of time in urinary surgery department. 1 case was mistaken for renal tubular diseases because of normocalcemic PHPT at the first visit in other tertiary hospitals. The misdiagnosed time was from 2 months to 10 years ( average time was 4. 74 ± 2. 94 years). 6 patients underwent surgery, and postoperative pathological diagnosis confirmed 4 cases of parathyroid adenoma;1 case of multiple parathyroid adenomas and 1 case of parathyroid carcinoma. After surgery, 5 patients were fol-lowed up from 1 to 11 months and the blood calcium and iPTH level decreased to normal limit;1 patient died of sepsis and systemic failure with elevated iPTH level. 1 patient died of hypercalcaemia crisis, complicated with acute kidney injures myo-cardial infarction and consciousness disturbance 2 days after diagnosis was confirmed. Conclusion The major cause for mis-diagnosis of PHPT is lack of clinical specificity and insufficient awareness of the disease by clinicians. Serum calcium, serum parathyroid hormone and bone density should be screened for suspected patients in order to make early diagnosis and rational treatment of PHPT patients.