ラマダン断食中の青年における原発性副甲状腺機能亢進症の症例報告

A case report of primary hyperparathyroidism in an adolescent during Ramadan fast.

抄録

原発性副甲状腺機能亢進症は小児ではまれであり、通常は非特異的な症状を呈する。ラマダン断食は、原発性副甲状腺機能亢進症の診断を覆い隠すことが報告されている。15歳の男児が救急外来を受診した。来院の1週間前からラマダン断食を開始していた。彼は、意図しない体重減少、腹痛、便秘、頻繁な頭痛、運動不耐性、疲労感、動悸を訴えた。身体診察では、疲れているように見えた以外は異常なし。検査の結果、カルシウムと副甲状腺ホルモンの上昇、低リン血症、ビタミンDの低下、副甲状腺腺腫が認められた。副甲状腺摘出術を受け、副甲状腺ホルモン値は低下した。術後の経過は良好で、11ヵ月後の診察時にはカルシウムは正常値に戻り、元気で体重も増えていた。若年患者、特にラマダン断食中の若年患者では、ほとんどが漠然とした非特異的症状を呈するため、原発性副甲状腺機能亢進症の診断には高い疑い指数が必要である。

Primary hyperparathyroidism is rare in children and usually presents with nonspecific symptoms. Ramadan fasting has been reported to unmask the diagnosis of primary hyperparathyroidism. A 15-year-old boy presented to the clinic for an emergency department follow up visit. He had started Ramadan fasting a week before his presentation to the clinic. He reported unintentional weight loss, abdominal pain, constipation, frequent headaches, exercise intolerance, tiredness, and palpitations. Physical examination was unremarkable except that he looked tired. Investigations revealed elevated calcium and parathyroid hormone, hypophosphatemia, low vitamin D, and parathyroid adenoma. He underwent parathyroidectomy, leading to a decrease in parathyroid hormone levels. He did well postoperatively, and by his 11-month follow-up visit, his calcium was back to a normal level, he was energetic, and had gained weight. A high index of suspicion is required to diagnose primary hyperparathyroidism in young patients, especially young Ramadan-fasting patients, who mostly present with vague nonspecific symptoms.