ARTICULAR AND FIBROCARTILAGE CALCIFICATION IN HYPERPARATHYROIDISM: ASSOCIATED HYPERURICEMIA.

Abstract

Recent publications have awakened interest in the significance of fibrocartilage and articular cartilage calcification as observed roentgenographically. It is apparent that a syndrome exists termed “pseudogout” by McCarty et al. (1) and “chondrocalcinosis articularis” by Zitnan and Sit'Aj (3) which is associated with a characteristic type of calcification. Zitnan and Sit'Aj have stressed the familial nature of the syndrome and McCarty and his co-workers (2) have studied the significance of calcium pyrophosphate crystals found in the synovial fluid during an acute attack. In this paper the author wishes to report 2 cases of hyperparathyroidism which showed an identical type of calcification, to emphasize that this may be a manifestation of a potentially curable disease. Reviews have stated that this calcification is “pathognomonic” (3) for “chondrocalcinosis articularis” and that in the condition called “pseudogout” the “serum levels of calcium, phosphorus, alkaline phosphatase, and uric acid were almost invariably within normal limits” (2). The author's 2 examples were found in a review of 21 cases of hyperparathyroidism and were both associated with hyperuricemia. The presence of hyperuricemia was noted in similar instances in the literature and will be briefly commented upon. Case Reports Case I: S. Z., a white woman, was fifty-eight years of age when first seen in June 1962, upon referral to the University of Minnesota Hospital with a known elevated serum calcium. Her chief complaint was pain in the lower extremities of about four months duration. Fifteen years previously a renal stone had been passed. Blood studies showed a serum calcium of 15 to 18.5 mg. per 100 c.c., phosphorus 2.5 to 3.9 mg. per 100 c.c., serum uric acid 9.0 to 10.8 mg. per 100 c.c., and a urea nitrogen 29 to 34 mg. per 100 c.c. X-ray studies disclosed evidence of calcification of the knee menisci bilaterally (Fig. 1), the ulnar-carpal articular disks bilaterally, the interphalangeal joint capsules (Fig. 2), and the articular cartilage of the proximal humerus (Fig. 3). On July 20 a parathyroid adenoma was surgically removed. This was followed by a period of temporary hypoparathyroidism. The patient has continued to have joint symptoms and has subsequently been treated for congestive heart failure due to coronary artery disease. Renal insufficiency is thought to be the result of chronic pyelonephritis. Eight months after removal of the parathyroid adenoma no change had been noted in the illustrated cartilage calcification. Case II: A. D., a 41-year-old male, was first seen at the Minneapolis VA Hospital in May 1954. History revealed that his first renal stone had been passed in 1942, and in 1946 a right nephrectomy was necessary because of obstructive hydronephrosis. Physical examination disclosed splenomegaly.