概述

高钙血症是血液中钙水平高于正常值的疾病。血液中钙含量过高会削弱骨骼,产生肾结石,并干扰心脏和大脑的运作。

高钙血症通常由甲状旁腺功能亢进所致。这四个小腺体位于颈部,靠近甲状腺。高钙血症的其他病因包括癌症、某些其他疾病、某些药物,以及服用过多钙和维生素 D 补充剂。

高钙血症体征和症状的程度从无症状到重度不等。根据病因确定治疗方法。

Treatment of parathyroid disease at Mayo Clinic

Here at the Mayo Clinic in Endocrine and Metabolic Surgery, we treat the full spectrum of parathyroid problems. And that ranges from the simplest primary hyperparathyroidism to the most complex cases.

What they are are four little glands that regulate the calcium. And most often, it's just one of them that develops a tumor of it.

We utilize multimodal imaging, meaning various types of imaging to identify where the abnormal parathyroid is located. And that can include various imaging techniques such as ultrasound, parathyroid sestamibi scan, which is a nuclear medicine imaging. We use four-dimensional CT scan, which is an advanced CT scan imaging of the neck and parathyroid glands. And finally, cutting-edge imaging such as choline PET scan.

So PET choline is one of the newest imaging modalities that's out there. It requires generation of a choline isotope onsite. And so this is not widely available. It's really only available at a few centers across the country. And so with this type of scan, we can find parathyroid glands that are otherwise missed by traditional imaging techniques.

Once that step is complete, then the patient can very confidently move towards the next step, which is treatment.

Patients can come into the office feeling a variety of symptoms that are generally nonspecific, but rather debilitating for them. In many of these cases, we're able to treat hyperparathyroidism and watch these symptoms literally go away.

What we strive for is really to have a very efficient and effective itinerary for patients and know they're going to be operated on by very high-volume, experienced parathyroid surgeons. You feel confident that they're going to come here and get the care they need and deserve.

症状

如果您的高钙血症较轻微,您可能不会出现任何体征或症状。更严重病例产生的体征和症状与血液中的高钙含量所影响的身体部位相关。例如:

  • 肾脏。过量的钙会使肾脏更难过滤。这会引起过度口渴和尿频。
  • 消化系统。高钙血症可引起胃不适、恶心、呕吐和便秘。
  • 骨骼和肌肉。在大多数情况下,血液中多余的钙是从骨骼中提取的,这会使骨骼变得脆弱。可能导致骨痛和肌无力。
  • 大脑。高钙血症会干扰大脑的工作方式,导致意识混乱、昏睡和疲劳。也可能导致抑郁症。
  • 心脏。在极少数情况下,严重的高钙血症会干扰您的心脏功能,引起心悸和昏厥、心脏心律失常的症状和其他心脏问题。

何时就医

如果您出现极度口渴、尿频和腹痛等可能暗示高钙血症的体征或症状,请就医。

病因

除了可构建强壮的骨骼和牙齿外,钙还有助于肌肉收缩和神经传递信号。通常情况下,如果血液中的钙含量不足,甲状旁腺会分泌一种触发以下反应的激素:

  • 骨骼向血液中释放钙
  • 消化道吸收更多的钙
  • 肾脏排泄更少的钙,并激活更多的维生素 D,维生素 D 对钙的吸收起着至关重要的作用

血液中钙过少和高钙血症之间的微妙平衡会被多种因素打破。引起高钙血症的原因包括:

  • 甲状旁腺过度活跃(甲状旁腺功能亢进症)。这是高钙血症最常见的原因,可能由于四个甲状旁腺中的一个或多个腺体出现非癌性(良性)小肿瘤或增大所致。
  • 癌症。肺癌、乳腺癌和某些血癌会增加患高钙血症的风险。癌症扩散(转移)至骨骼也会增加风险。
  • 其他疾病。某些疾病(如结核病和结节病)会增加血液中的维生素 D 水平,从而刺激消化道吸收更多的钙。
  • 遗传因素。家族性低钙尿高钙血症这种罕见的遗传病会导致体内的钙受体缺陷,从而增加血液中的钙含量。这种疾病不会引起高钙血症的症状或并发症。
  • 缺乏活动。因疾病而需要久坐或久卧的患者可能患高钙血症。随着时间的推移,无法负重的骨骼会将钙释放到血液中。
  • 严重脱水。轻度或暂时性高钙血症的常见原因之一是脱水。血液中液体减少会导致钙浓度升高。
  • 药物。某些药物(如用于治疗双相障碍的锂剂)可能会增加甲状旁腺激素的释放量。
  • 补充剂。长期服用过量的钙或维生素 D 补充剂会使血液中的钙水平高于正常水平。

并发症

高钙血症并发症可能包括:

  • 骨质疏松症。如果骨骼继续向血液中释放钙,您可能患上导致骨头变薄的疾病(骨质疏松症),从而出现骨折、脊柱弯曲和体重减轻。
  • 肾结石。如果尿液中的钙含量过高,您的肾脏中就有可能形成晶体。随着时间的积累,晶体会结合在一起形成肾结石。排出肾结石的过程可能极度疼痛。
  • 肾功能衰竭。严重的高钙血症会损伤您的肾脏,限制其净化血液和排除液体的能力。
  • 神经系统问题。严重的高钙血症会引起意识混乱、痴呆和可能致命的昏迷。
  • 心律异常(心律失常)。高钙血症会影响调节心跳的电脉冲,导致心脏不规则跳动。

April 14, 2023
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  2. AskMayoExpert. Hypercalcemia. Mayo Clinic; 2019.
  3. Hypercalcemia. Hormone Health Network. https://www.hormone.org/diseases-and-conditions/hypercalcemia. Accessed Jan. 22, 2020.
  4. Shane E, et al. Treatment of hypercalcemia. https://www.uptodate.com/contents/search. Accessed Jan. 22, 2020.
  5. Feingold KR, et al, eds. Approach to hypercalcemia. In: Anatomy and Ultrastructure of bone – Histogenesis, growth and remodeling. MDText.com. 2019. https://www.ncbi.nlm.nih.gov/books/NBK279129/. Accessed Jan. 23, 2020.

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