Hipertiroidismo primario con nefrolitiasis en mujer menopaúsica a propósito de un caso
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Fecha
2019
Autores
Arias Loyola, María Luisa
Rojas, Joselyn
Bermúdez, Valmore
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Sociedad Venezolana de Farmacología y Terapéutica
Resumen
Introducción: El hiperparatiroidismo primario es el aumento en los niveles de paratohormona (PTH), su cuadro clínico se caracteriza por síntomas de hipercalcemia, nefrolitiasis, enfermedad
mineral ósea, síntomas neuromusculares, también existen cuadros asintomáticos; la nefrolitiasis ocurre en un 4 a 15% de los pacientes, y esta enfermedad suele aparecer en mujeres en la menopausia. Caso Clínico: Paciente femenina de 65 años de edad, que presenta cuadro clínico caracterizado por dolor en hipogastrio de leve intensidad que se irradia a región lumbar se acompaña de disuria, poliuria, coluria, tenesmo vesical y cefalea de moderada intensidad, la paciente refiere recurrencias de este cuadro clínico. Sus exámenes de laboratorio revelan estos
datos calcemia de 12 mg/dl, calciuria 310 mg/24 horas, fosfatemia 2.1 mg/dl, fosforo en orina 150 mg/24 horas, magnesio 2.2 mg/dl, PTH 120 pg/ml con lo que se realiza el diagnostico
de hiperparatiroidismo primario. Su ecografía renal muestra cálculos renales bilaterales y su densitometria ósea demuestra osteopenia en columna lumbar y osteoporosis en cabeza
del femur con T score -1 y -2 respectivamente. Se piden otros exámenes complementarios y se recomienda alendronato y cirugía de paratiroides. Conclusiones: El mejor tratamiento para la paciente seria la paratiroidectomia, sin embargo aún se carece de exámenes necesarios para el tratamiento tanto del hiperparatiroidismo y de la litiasis renal como centellograma de paratiroides y una tomografía computarizada.
Introduction: Primary hyperparathyroidism consists in the increased levels of parathyroid hormone (PTH), the clinical picture is characterized by symptoms of hypercalcemia, nephrolithiasis, bone mineral disease, neuromuscular symptoms, there are also asymptomatic presentations; nephrolithiasis occurs in 4-15% of patients, and the disease usually occurs in women at menopause. Case Report: Female patient, 65 years of age who presented with a clinical picture characterized by lower abdominal pain of mild intensity that radiates to lower back accompanied by dysuria, polyuria, dark urine, urgency and headache of moderate intensity, the patient reported recurrence of this symptoms. Her lab tests reveal this information calcemia of 12 mg/dl, 310 mg/24 hour urine calcium, serum phosphorus 2.1 mg/dl, phosphorus 150 mg/24 hours in urine, magnesium 2.2 mg/dl, PTH 120 pg/ml which reveal the diagnosis of primary hyperparathyroidism. Her renal ultrasound showed bilateral kidney stones and bone densitometry at the lumbar spine shows osteopenia and osteoporosis in femur head with T score -1 and -2 respectively. Other tests are ordered and alendronate and parathyroid surgery is recommended. Conclusions: The best treatment for the patient would be the parathyroidectomy, however still lacks examinations necessary for the treatment of both hyperparathyroidism and renal lithiasis, its necessary parathyroid scintigraphy and computed tomography.
Introduction: Primary hyperparathyroidism consists in the increased levels of parathyroid hormone (PTH), the clinical picture is characterized by symptoms of hypercalcemia, nephrolithiasis, bone mineral disease, neuromuscular symptoms, there are also asymptomatic presentations; nephrolithiasis occurs in 4-15% of patients, and the disease usually occurs in women at menopause. Case Report: Female patient, 65 years of age who presented with a clinical picture characterized by lower abdominal pain of mild intensity that radiates to lower back accompanied by dysuria, polyuria, dark urine, urgency and headache of moderate intensity, the patient reported recurrence of this symptoms. Her lab tests reveal this information calcemia of 12 mg/dl, 310 mg/24 hour urine calcium, serum phosphorus 2.1 mg/dl, phosphorus 150 mg/24 hours in urine, magnesium 2.2 mg/dl, PTH 120 pg/ml which reveal the diagnosis of primary hyperparathyroidism. Her renal ultrasound showed bilateral kidney stones and bone densitometry at the lumbar spine shows osteopenia and osteoporosis in femur head with T score -1 and -2 respectively. Other tests are ordered and alendronate and parathyroid surgery is recommended. Conclusions: The best treatment for the patient would be the parathyroidectomy, however still lacks examinations necessary for the treatment of both hyperparathyroidism and renal lithiasis, its necessary parathyroid scintigraphy and computed tomography.
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Palabras clave
Hiperparatiroidismo, Nefrolitiasis, Cálculos renales, Osteoporosis, Hyperparathyroidism, Nephrolithiasis