假性痛風合併原發性副甲狀腺機能亢進患者於副甲狀腺切除術後改善其急性關節炎之發作──兩例病例報告與文獻回顧

Improvement of Acute Pseudogout Attacks after Parathyroidectomy in Patients with Pseudogout and Primary Hyperparathyroidism Two Cases Report and Review of Literature

假性痛風為年老族群中常見之急性單一性或是多發性關節炎之一。此疾病乃為calcium pyrophosphate clihydrate （CPPD） 結晶沉積於受侵犯的關節液中所造成。臨床上其被認為與原發性副甲狀腺機能亢進 （Primary hyperparathyroiclism） 有關。病患若長時期處於副甲狀腺機能亢進所造成之高鈣血症之情況下，CPPD晶體沉積於關節軟骨造成軟骨鈣化之發生率便更高。此種狀況下，若病患接受副甲狀腺切除手術之治療方式，於術後相對地“低鈣血症＂時期便又成為一刺激晶體沒入關節液之因素，反使得這個期間假性痛風更易發作。因此，於副甲狀腺切除術後試著補充鈣質以預防術後相對地低鈣血症所引發假性痛風之發作乃一合理之考量。在此，我們將介紹二位合併有假性痛風與原發性副甲狀腺機能亢進之女性病患，二者皆為single-gland clisease，且在接受副甲狀腺切除術後於長期追蹤下很明顯地改善其急性關節炎發生之頻率，然其一（case 2）因未能於術後立即補充鈣而導致術後低蓋血症與急性關節炎之併發症。

Pseudogout is a clinical entity characterized by acute arthritis in one or more joints associated with the presence of calcium pyrophosphate dehydrate (CPPD) crystals in the synovial fluid of the affect joints. It is also known as a biochemical entity associated with primary hyperparathyroidism and it may offer a useful clue to screen the disease. Patients with long standing hypercalcemia related to hyperparathyroidism have a high incidence of CPPD crystal deposition in the articular cartilage which is so called chondrocalcinosis. In patients of CPPD deposition disease with primary hyperparathyroidism, relative hypocalcemia after parathyroidectomy could provide stimulus for crystal shedding into synovial fluid, which may precipitate acute attacks of pseudogout. Thus, trying calcium supplement after parathyroid surgery may be a good and reasonable consideration to prevent the postoperative complication. Here, we illustrate two female patients of pseudogout related arthritis with primary hyperparathyroidism, and, both of them have single-gland disease who go on parathyroidectomy experienced much improvement in pseudogout attacks after surgical interventions.