原発性副甲状腺機能亢進症による高カルシウムクリーゼに対しゾレドロネートが奏効した末期腎不全患者の1例  [in Japanese] Hypercalcemic crisis due to primary hyperparathyroidism treated by zoledronate in a patient with end-stage renal disease  [in Japanese]

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Author(s)

Abstract

高カルシウム(Ca)クリーゼは重篤で生命の危険を伴う電解質異常であり,原発性副甲状腺機能亢進症(primary hyperparathyroidism:PHPT)によるものが多数を占める.症例は80歳,男性.糖尿病および慢性腎不全にて外来加療中.2009年夏に食欲低下,全身倦怠感を自覚.1か月後,傾眠傾向と構音障害が出現し当院救急外来を受診.慢性腎不全の増悪と著明な高Ca血症(16.3mg/dL:アルブミン補正値)を認めたため入院.血液透析導入とともにエルカトニンを投与したが,徐々に効果減弱.アレンドロネートの内服を開始したが効果不十分であった.そこでゾレドロネート4mgの点滴投与を行ったところ,血清Ca値は正常化し症状も改善した.臨床経過および画像検査にて原発性副甲状腺機能亢進症と診断.外科的に切除し臨床所見は改善した.慢性腎不全に原発性副甲状腺機能亢進症による高Caクリーゼを合併するケースは比較的まれである.透析患者の高Caクリーゼに対してゾレドロネートを使用した報告はないが,本例では副作用の出現なく有効に使用可能であったことから,今後選択しうる治療法の一つであると考えられた.

Hypercalcemic crisis is a serious and potentially life-threatening complication of markedly increased serum calcium concentrations most commonly due to primary hyperparathyroidism. We report a case of an 80-year-old man with diabetes mellitus and chronic renal failure, who presented to the emergency department with somnolence, dysarthria and severe hypercalcemia (16.3mg/dL). Despite intensive treatment including elcatonin, alendronate, and intermittent hemodialysis with low calcium dialysate, serum calcium still reached high levels between hemodialysis treatments. The patient was then treated with 4mg of intravenous zoledronate. This treatment greatly reduced the serum calcium level and improved clinical symptoms without major adverse effects. The patient was diagnosed as having primary hyperparathyroidism and was treated by parathyroidectomy. Administration of zoledronate seems to be an effective modality for hypercalcemic crisis in patients with end-stage renal disease.

Journal

  • Nihon Toseki Igakkai Zasshi

    Nihon Toseki Igakkai Zasshi 44(4), 313-318, 2011-04-28

    The Japanese Society for Dialysis Therapy

References:  10

Codes

  • NII Article ID (NAID)
    10029406282
  • NII NACSIS-CAT ID (NCID)
    AN10432053
  • Text Lang
    JPN
  • Article Type
    NOT
  • ISSN
    13403451
  • NDL Article ID
    11102405
  • NDL Source Classification
    ZS39(科学技術--医学--皮膚科学・泌尿器科学)
  • NDL Call No.
    Z19-1413
  • Data Source
    CJP  NDL  J-STAGE 
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