一過性反回神経麻痺の原因が副甲状腺腺腫であったと推察された1例

Transient recurrent laryngeal nerve palsy associated with parathyroid adenoma

はじめに

　一般的に副甲状腺腺腫（parathyroid adenoma：PA）は倦怠・脱力感，腹痛や消化不良などの消化器症状，骨痛や腎結石症など，副甲状腺機能亢進に伴う多彩な症状を呈することが多い。その一方で反回神経麻痺を生ずることは稀であるため，一側性声帯麻痺がみられた場合，反回神経の走行領域に副甲状腺腺腫が存在すれば，副甲状腺癌（paratyhroid adenocarcinoma：PAC）を疑うことがある。

　今回われわれは，声帯麻痺に伴う嗄声を契機に副甲状腺腺腫が発見された1例を経験したが，嗄声が一過性であったことも加えて，副甲状腺癌との鑑別に苦慮したため，文献的考察を含めて報告する。

　We report the case of a 66-year-old woman with a parathyroid adenoma（PA） that presented with transient recurrent laryngeal nerve palsy（RNP）. PA accompanied by RNP is rare, and parathyroid tumors concomitant with RNP are suggestive of parathyroid adenocarcinoma（PAC）. However, distinguishing between PA and PAC was difficult owing to transient RNP. Finally, based on intraoperative findings and rapid pathology results, the parathyroid tumor was provisionally diagnosed as a PA and was resected. Later, the tumor was definitively diagnosed as PA. Limited evidence is available to support that RNP and concomitant nerve-tumor adhesions strongly suggest PAC；therefore, surgeons should attempt to preserve the RN by careful ablation during parathyroid tumor operations.