Calcium and Phosphorus Studies in a Case of Clinical Hyperparathyroidism.

Abstract

The subject of this study was a boy of 19, with progressing bowing of the legs, and other evidence of bone softening. On admission the serum calcium was 16.8, serum inorganic phosphorus 3.0 mg. per 100 cc. Notwithstanding a high calcium intake, the patient was losing about 0.5 gm. of calcium a day. The urinary calcium was 2 to 3 times the normal output while the fecal calcium nearly equalled the intake. There was a retention of phosphorus but the urinary phosphorus was above normal. On the basis of the laboratory and roentgenological findings, a clinical diagnosis of hyperparathyroidism with resultant generalized osteitis fibrosa, , , was made. Exploration revealed an adenoma of the left lower parathyroid, which was removed. Just prior to operation, serum calcium was 17.5 mg., serum phosphorus 2.2 mg. per 100 cc.; 18 hours after operation the serum calcium had fallen to 12.3 mg. per 100 cc. It continued to fall, but more slowly, the values for the succeeding days being 10.7 and 8.5 mg. per 100 cc. respectively. The inorganic phosphorus of the serum remained low. From the second to the sixth day after operation a total of 6 cc. of parathyroid extract was given hypodermically. Ten days after the removal of the adenoma, with the same diet as during the period of preoperative observation, the patient was retaining about 0.25 gm. of calcium and 0.6 gm. of phosphorus a day. The urinary secretion of calcium had fallen to below normal values; the urinary phosphorus also was decreased, but to a lesser extent. At this time the serum calcium was 5.0 mg., phosphorus 3.0 mg. per 100 cc. Chvostek's sign became strongly positive the second day following operation and remained so for several days; no further signs of tetany were noted.