Improvement of Acute Pseudogout Attacks after Parathyroidectomy in Patients with Pseudogout and Primary Hyperparathyroidism-Two Cases Report and Review of Literature

Abstract

Pseudogout is a clinical entity characterized by acute arthritis in one or more joints associated with the presence of calcium pyrophosphate dihydrate (CPPD) crystals in the synovial fluid of the affect joints. It is also known as a biochemical entity associated with primary hyperparathyroidism and it may offer a useful clue to screen the disease. Patients with long standing hypercalcemia related to hyperparathyroidism have a high incidence of CPPD crystal deposition in the articular cartilage which is so called chondrocalcinosis. In patients of CPPD deposition disease with primary hyperparathyroidism, relative hypocalcemia after parathyroidectomy could provide stimulus for crystal shedding into synovial fluid, which may precipitate acute attacks of pseudogout. Thus, trying calcium supplement after parathyroid surgery may be a good and reasonable consideration to prevent the postoperative complication. Here, we illustrate two female patients of pseudogout related arthritis with primary hyperparathyroidism, and, both of them have single-gland disease who go on parathyroidectomy experienced much improvement in pseudogout attacks after surgical interventions.