problendoПроблемы ЭндокринологииProblems of Endocrinology0375-96602308-1430Endocrinology Research Centre10.14341/probl10107problendo-10107Research ArticleКлинические случаиCase ReportsКлинический случай сочетания дифференцированного рака щитовидной железы и первичного гиперпаратиреоза: сложности топической дифференциальной диагностикиA clinical case of combined differentiated thyroid cancer and primary hyperparathyroidism: the complexity of topical differential diagnosishttps://orcid.org/0000-0002-3220-2438СлащукКонстантин ЮрьевичSlashchukKonstantin Yu.

научный сотрудник, врач-эндокринолог

MD

slashuk911@gmail.comhttps://orcid.org/0000-0001-5652-2607ДегтяревМихаил ВладимировичDegtyarevMikhail V.

заведующий отделением радионуклидной диагностики ОРНДТ

MD

germed@mail.ruhttps://orcid.org/0000-0003-2326-1396СерженкоСергей СергеевичSerzhenkoSergey S.

врач-рентгенолог, отдел радионуклидной диагностики и терапии

MD

vv1ld@yandex.comhttps://orcid.org/0000-0002-7721-634XРумянцевПавел ОлеговичRumyantsevPavel O.

д.м.н.

MD, PhD

pavelrum@gmail.comhttps://orcid.org/0000-0003-3785-0335ШереметаМарина СергеевнаSheremetaMarina S.

кандидат медицинских наук, заведующая отделением радионуклидной терапии

MD, PhD

marina888@yandex.ruhttps://orcid.org/0000-0002-7624-7953ЯсюченяВалентина СергеевнаYasucheniaValentina S.

MD

loveissiberia@gmail.comhttps://orcid.org/0000-0001-5592-4727ТрухинАлексей АндреевичTrukhinAlexey A.alexey.trukhin12@gmail.comhttps://orcid.org/0000-0002-0613-9543СиротаЯрослав ИгоревичSirotaYaroslav I.yaroslawsirota@gmail.comhttps://orcid.org/0000-0001-7548-9056БарановаОльга ДмитриевнаBaranovaOlga D.

клинический ординатор

MD

olga.dm1091@gmail.comhttps://orcid.org/0000-0003-4031-5050НикифоровичПетр АлексеевичNikiforovichPetr A.

MD

nikiforovichdoc@gmail.comФГБУ “Национальный медицинский исследовательский центр эндокринологии” Минздрава РоссииРоссияEndocrinology Research CentreRussian Federation201925102019654243250Copyright © Слащук К.Ю., Дегтярев М.В., Серженко С.С., Румянцев П.О., Шеремета М.С., Ясюченя В.С., Трухин А.А., Сирота Я.И., Баранова О.Д., Никифорович П.А., 20192019Слащук К.Ю., Дегтярев М.В., Серженко С.С., Румянцев П.О., Шеремета М.С., Ясюченя В.С., Трухин А.А., Сирота Я.И., Баранова О.Д., Никифорович П.А.Slashchuk K.Y., Degtyarev M.V., Serzhenko S.S., Rumyantsev P.O., Sheremeta M.S., Yasuchenia V.S., Trukhin A.A., Sirota Y.I., Baranova O.D., Nikiforovich P.A.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.probl-endojournals.ru/jour/article/view/10107

За последние годы существенно изменилось представление об эпидемиологии, клинике и тактике ведения пациентов с гиперпаратиреозом. Наиболее часто в клинической практике встречается спорадический вариант первичного гиперпаратиреоза, который на сегодняшний день занимает третье место по распространенности среди эндокринных заболеваний (частота встречаемости во взрослой популяции составляет в среднем 1–2%). При первичном гиперпаратиреозе чаще всего выявляется солитарная аденома околощитовидной железы (ОЩЖ) – до 85% всех случаев. Единственный радикальный метод лечения – хирургическое удаление патологически измененной паратиреоидной ткани. Ранняя диагностика и лечение гиперпаратиреоза позволяют избежать тяжелых поражений костей скелета и висцеральных органов. Представлен сложный с диагностической точки зрения клинический случай сочетания онкоэндокринной патологии у пациента 70 лет. Основные трудности в первичной диагностике были связаны с отсутствием патогномоничных симптомов заболевания, нередко и вовсе протекающего бессимптомно. Наиболее актуальной проблемой представляется топическая локализация патологически измененных ОЩЖ, в связи с чем возникает необходимость разработки алгоритма по последовательному применению и комбинации методов медицинской визуализации.

In recent years, the understanding of the epidemiology, symptoms and strategies for managing patients with hyperparathyroidism has changed significantly. The most common cases in clinical practice are of sporadic primary hyperparathyroidism, which today ranks third in prevalence among endocrine diseases (the frequency of occurrence in the adult population is, on average, 1–2%). In primary hyperparathyroidism, solitary parathyroid adenoma is detected in up to 85% of all cases. The only treatment is radical surgical removal of pathologically altered parathyroid tissue. Early diagnosis and treatment of hyperparathyroidism makes it possible to avoid severe lesions of the skeletal bones and visceral organs. A diagnostically challenging clinical case of a combined onco-endocrine pathology in a 70-year-old patient is presented. The main difficulties in the initial diagnosis were associated with the absence of pathognomonic symptoms of the disease, which was often completely asymptomatic. The most urgent problem appears to be the topical diagnosis of pathologically altered parathyroid glands. Therefore, there is a need to develop an algorithm for the combining and sequential use of existing medical imaging methods.

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The authors declare that there are no conflicts of interest present.