Хондрокальциноз как ранний признак первичного гиперпаратиреоза

Abstract

Objective: To deeply analyse a case of a patient with calcium pyrophosphate crystal storage disease, where chondrocalcinosis (CC) preceded primary hyperparathyroidism (PHPT). Key Points. The association of CC and hyperparathyroidism is well-known; and CC is recognised as one of the late signs of hyperparathyroidism. We describe a 67-year old patient with PHPT, presenting for a long time only with X-ray CC and chronic arthritis, associated with calcium pyrophosphate deposits. At the same time, he did not have any electrolyte imbalances, had normal serum calcium and parathyroid hormone levels; PHPT was diagnosed after 10 years of follow-up when the patient developed life-threatening hypercalcemia. It can be assumed that, unlike other musculoskeletal signs, CC can be one of the earliest symptoms of hyperparathyroidism. Treating CC as a late sign of hyperparathyroidism is likely to be associated with challenges of early diagnosis (asymptomatic in some patients, low sensitivity of X-ray diagnostics). In order to assess the diagnostic value of CC in hyperparathyroidism, including patients with normal calcium levels, specific tests are essential. Conclusion. Target examination for CC using highly-sensitive methods in patients with minor calcium metabolism disturbances, high/normal parathyroid hormone level or slightly increased parathyroid hormone level and normal calcium can improve the detection frequency of both CC and PHPT and follow-up of such patients. Early PHPT diagnosis (prior to clinical presentation) can help in preventing severe, life-threatening complications. Keywords: chondrocalcinosis, primary hyperparathyroidism, parathyroid hormone, calcium pyrophosphate crystal storage disease, hypercalcemia.