末端肥大症に合併した尿路結石症

A Case of Urolithiasis Associated with Acromegaly

　患者は31歳，男性。右下腹部痛，肉眼的血尿を主訴に受診した。KUBで右尿管結石，左珊瑚状結石を認めたが，右尿管結石はすみやかに自然排石した。過Ca尿症とともに成長ホルモンの異常分泌を認めた。さらに，頭蓋内CTおよびMRI検査で下垂体腺腫を確認した。尿路結石症を合併した末端肥大症と診断し，まず脳神経外科に依頼し経蝶骨洞下垂体腺腫摘出術を施行した。左腎珊瑚状結石に対しては体外衝撃波結石破砕術（以下，ESWL）を施行した。

Many litaratures have been reported that acromegaly is often associated with hypercalciuria, but there are few reports on the frequency of the urolithiasis. We report a 31-year-old man with the chief complaint of right lumbago and macroscopic hematuria. His KUB demonstrated right small ureteral calculi and left staghorn kidney. The physical examination and laboratory findings were of typical acrome-galic features with hypercalciuria. Firstly hypophysectomy for pituitary adenoma was perfonmed, and the serum GH and urinary excertion of calcium decreased significantly after the treatment of acromegaly.