全身性紅斑狼瘡合併自發性副甲狀腺功能低下症

Systemic Iupus Erythematosus Associated with Idiopathic Hypoparathyroidism

自發性副甲狀腺功能低下症被認為是一種自體免疫疾病，可與自體免疫性甲狀腺炎、腎上腺功能低下症、惡性貧血、類風濕性關節炎、修格蘭氏症候群等合併發生。自發性副甲狀腺功能低下症合併全身性紅斑狼瘡，在文獻上只有兩例病例報告。第一例未提及紅斑狼瘡的治療，第二例雖然使用大量類固醇治療，但副甲狀腺荷爾蒙持續偏低。本篇報告一位21歲全身性紅斑狼瘡女性病患發生自發性副甲腺功能低下症，使用類固醇治療後副甲狀腺功能回復正常，爾後紅斑狼瘡疾病惡化時均合併復發副甲狀腺功能低下症，證實兩者自體免疫之相關性。全身性紅斑狼瘡病患發生低血鈣症之情形並非少見；血中蛋白低下，狼瘡性腎炎合併慢性腎衰竭，食物中的鈣、鎂、維生素D、蛋白質攝取不足均可能導低血鈣症。但當紅斑狼瘡病患發生原因不明確的低血鈣症時，也要考慮是否併發自發性副甲狀腺功能低下症，檢測副甲狀腺荷爾蒙是必要的。

Idiopathic hypoparathyroidism and systemic lupus erythematosus (SLE) were diagnosed concurrently in a 21-year-old Chinese woman. As the severity of hypoparathyroidism paralleled to that of lupus, our case study suggests an autoimmune pathogenetic mechanism for idiopathic hypoparathyroidism. This case also represents the first report of significant improvement of both SLE and hypoparathyroidism with corticosteroid therapy.