洗腎病人經副甲狀腺手術後併低血鈣與難治性低血壓：個案報告與文獻回顧

Refractory Hypotension in a Maintenance Hemodialysis Patient with Hypocalcemia Post-parathyroidectomy: A Case Report

規律洗腎的病人經常因為次發性副甲狀腺功能亢進接受副甲狀腺手術切除。餓骨症候群是在接受副甲狀腺手術切除後的病人引發難治性低血鈣常見的鑑別診斷。他們的實驗數據也同時出現低血磷與正常數據之副甲狀腺素。另一方面，低血鈣引起的低血壓臨床相對少見。個案為70歲女性，主訴為頭暈一天．她的過去病史包括糖尿病引起之末期腎病變經長期規則洗腎，次發性副甲狀腺亢進於一年前接受副甲狀腺切除手術。副甲狀腺切除手術術前評估，實驗數據顯示輕微高血鈣（10.6 mg/dL）、正常血磷（4.9 mg/dL）與副甲狀腺功能亢進（2134.7 pg/mL）。術後一週數據顯示持續性低血鈣（7.1 mg/dL）與輕微副甲狀腺功能低下（13.7 pg/mL）。回到病人這次住院經過，她的生命徵象呈現低血壓，實驗數據呈現低血鈣。住院過程我們積極補充鈣離子，低血壓也隨著鈣離子補充而有顯著的改善。血壓穩定後安排出院。總結而言，餓骨症候群不常見。但在副甲狀腺切除的病人併發難治性低血鈣必須強烈懷疑。另外，難治性透析中低血壓需考慮低血鈣引起的可能性。

Patients treated with maintenance hemodialysis often undergo parathyroidectomy for secondary hyperparathyroidism. Hungry bone syndrome (HBS) is a differential diagnosis in refractory hypocalcemia patients who have undergone parathyroidectomy. Their laboratory test results often reveal hypophosphatemia and normal parathyroid hormone levels. Moreover, hypocalcemia-induced hypotension is a rare clinical diagnosis. Herein we report a 70-year-old woman who experienced dizziness for the duration of a day. Her medical history included diabetes mellitus with end-stage renal disease, maintenance hemodialysis, and hyperparathyroidism, which occurred after a total parathyroidectomy that was performed one year ago. Before parathyroidectomy, her laboratory data revealed elevated serum calcium levels (10.6 mg/dL), normal phosphorus levels (4.9 mg/dL), and aggressive hyperparathyroidism (2134.7 pg/mL). One week after the surgery, prolonged hypocalcemia (7.1 mg/dL) and mild hypoparathyroidism (13.7 pg/mL) were noted.
At the time of admission, her vital signs showed hypotension, and laboratory data revealed hypocalcemia (7.1 mg/dL). We increased the dosage strength of the calcium supplements, and the hypotension status improved dramatically. In conclusion, HBS is relatively uncommon, but it should be considered in patients with refractory hypocalcemia who have undergone a parathyroidectomy. Additionally, hypocalcemia-induced hypotension should be considered in the differential diagnosis of refractory intradialytic hypotension.