臨牀透析 Vol.13 No.1(7)


特集名 副甲状腺機能低下症
題名 偽性副甲状腺機能低下症
発刊年月 1997年 01月
著者 山本 通子 防衛医科大学校第三内科
【 要旨 】 偽性副甲状腺機能低下症ではPTHの標的細胞がPTHに対して不応であるために異常が生じる.低Ca高P血症とPTH高値が特徴的検査所見である.臨床像やPTH不応の機序の差異によっていくつかの病型に分類することができるが,本症の大半を占めるのはcAMP産生系の障害を示すI型である.I型はしばしばAlbright遺伝性骨形成異常症と呼ばれる特徴的な身体所見(円形顔貌,低身長,中手骨や中足骨の短縮,皮下骨腫など)を合併し,PTH以外のホルモンに対する標的組織の不応性も認められる.症状や所見の大部分は低Ca血症に由来するものであり,PTH分泌低下による副甲状腺機能低下症と共通している.治療は低Ca血症の是正を目的に活性型ビタミンD剤を投与する.
Theme Hypoparathyroidism and Related Problems in Dialysis Patients
Title Pseudohypoparathyroidism
Author Michiko Yamamoto 3rd Department of Internal Medicine, National Defense Medical College
[ Summary ] Pseudohypoparathyroidism (PsH) is characterized by the biochemical abnormalities of hypoparathyroidism (hypocalcemia and hyperphosphatemia), increased serum PTH levels, and resistance to exogenous PTH. PsH is classified into several subtypes (types Ia, Ib, Ic and II) according to differences in pathogenesis, laboratory findings and clinical features. The majority of patients belong to type I PsH which is caused by a defective cAMP signaling system. Physical characteristics such as short stature, brachydactyly and round face, termed as Albright's hereditary osteodystrophy, are often seen in patients with type I PsH. The differential diagnosis of PsH includes other forms of hypoparathyroidism and pseudo-PsH (Albright's hereditary osteodystrophy without hypoparathyroidism). Patients with PsH can be successfully treated with active vitamin D [1,25(OH)2D3, or its analog, 1-alphaOH D3].
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