Editor's Notes http://www.cixip.com/index.php/page/content/id/1922
Figure 60.4.2. A: Plain anteroposterior radiograph of a lytic metastatic lesion with impending fracture of the peritrochanteric region of the femur. B: Plain anteroposterior radiograph after treatment with reconstruction intramedullary nail, providing fixation into the femoral head. http://synapse.koreamed.org/DOIx.php?id=10.5292/jkbjts.2011.17.1.44&vmode=PUBREADER#!po=90.0000 http://www.clinicaloptions.com/Oncology/Treatment%20Updates/Bone%20Health%20Nursing/Module/Bone_Health/Pages/~/media/Oncology/Programs/Bone%20Health%20Nursing/Faiman_Figure2.ashx http://www.tmhc.co.uk/Tumours http://www.radiologyassistant.nl/en/p4bc9a97980036/sclerotic-bone-tumors-and-tumor-like-lesions.html#i4bc9ac5119bc3 http://www.orthotumours.ca/images-content/pathology/FIGChondrosarcomaXR_large.jpg http://www.orthotumours.ca/knowledge-base/pathology.htm#sthash.ivkMRlDX.dpbs 一、 副甲狀腺機能亢進症(Hyperparathyroidism)二、棕色瘤 ( Brown tumor ):是由副甲腺素 ( PTH ) 分泌過多,刺激破骨細胞生長,引起廣泛性骨吸收、纖維化、出血、甚至囊性變,進一步引起假性腫瘤。因其組織中多核巨大細胞 ( giant cell ) 的細胞質中含有RBC、hemosiderin而呈棕色,故稱棕色瘤。【 說明 】 一、正常成年體內99%的鈣存在骨骼中,而1%的鈣分佈在細胞外液,在神經傳導及肌肉收縮過程扮演重要角色。:
副甲狀腺素(PTH)是維持體內鈣磷平衡、調節血鈣最重要的Hormone之一:
當血中鈣下降時,PTH分泌,可促使骨骼釋出鈣質,並刺激維生素D3的合成,增加小腸對鈣質的吸收,並降低尿鈣排泄,以恢復血鈣正常值;
PTH可促進尿磷排出,以降低血磷濃度。
二、 PTH 分泌過多,根據病因,可分為原發性與繼發性副甲狀腺功能亢進症:
原發性: 85%良性腺瘤,15%則是副甲狀腺增生,極少數是副甲狀腺癌,皆可使PTH分泌過多,大量鈣質從骨骼中釋出,引起血鈣上升,造成高血鈣症,出現神經、肌肉、骨骼、腸胃道症狀,包括疲勞、肌肉酸痛、高血壓、骨質疏鬆、食慾減退、噁心、嘔吐、便秘、消化性潰瘍、胰臟炎、口渴、多尿、記憶力減退等,嚴重時會造成昏迷;此外,尿鈣增加,易造成腎結石
繼發性:多發生在腎功能不全患者,此乃腎臟無法製造有活化的維生素D,造成血鈣較低,進一步刺激副甲狀腺增生,以分泌較多的PTH以維持正常血鈣。另外,腎功能不全患者,PTH分解代謝降低,造成血中PTH濃度升高