精神症状を主徴とする原発性副甲状腺機能亢進症

Psychiatric Disorders in Primary Hyperparathyroidism

　抄録　抑うつ・幻覚妄想状態で治療中に高Ca血症よりPHPTと診断し，手術にて副甲状腺腫が確認された2症例を報告した。術後Ca値の低下とともに精神症状は消失し，現在まで各々6カ月，12カ月経過するも再燃はみられない。1例では身体症状を除く精神症状のみに対しては向精神薬が一過性ながら有効であった。他例ではlevodopaと高Ca血症とが相乗的に作用したと考えられた。Mg代謝異常は認められなかった。精神症状の発現機序を考察するとともに，とくに中年女性における抑うつ，幻覚妄想状態における鑑別診断上の重要性を強調した。

　Two cases with psychiatric symptoms as dominant manifestations of primary hyperparathyroidism (PHPT) were reported. The first case is a 68-year-old housewife who has developed a change of character with depression and delusion. She had recovered mentally with haloperidol and sulpiride. However, her mental symptoms became worse while she was at home. Laboratory data revealed hypercalcemia (max. 11.0mg/dl) and a decrease of %TRP, and she was diagnosed as PHPT.

　The second case is a 60-year-old housewife who had suffered from Parkinson's disease for ten years and had been treated with levodopa. She showed signs of depression and hallucination. Laboratory data revealed hypercalcemia (max. 15.0mg/dl) and a decrease of phosphorus and %TRP, and diagnosis was made of PHPT. Surgical operation was performed on both cases and adenoma was indentified pathologically. Postoperatively, psychiatric and physical symptoms subsided and Ca concentration was down to normal range. Magnesium metabolism was normal in both cases.

　Review of literature on psychiatric manifestations of primary hyperparathyroidism was made and relationship of mental symptoms and hypercalcemia was discussed. Importance of differential diagnosis of depresion, delusions and hallucinations in women of 50 years or older was stressed.