Abstract
An extensive review of the publications on primary hyperparathyroidism (pHPT) is presented in this report. It has strongly been emphasized in the literature that patients with pHPT may present either with the classical symptomatology or with asymptomatic disease, emerged due to biochemical screening. The clinical and epidemiological presentation of pHPT in western countries has changed profoundly during the past few decades, and bone disease is nowadays a distinct rarity. The introduction of serum calcium screening for osteoporosis and the technological advances in the laboratory assessment of parathyroid hormone have played important roles in early diagnosis. Subsequently, the disease is increasingly being detected as asymptomatic hypercalcaemia without guiding signs or symptoms. A third type of disease, the normocalcaemic variant, has been recently described in the literature. However, the potential diagnosis of pHPT should always be on the orthopaedics’ list of differential diagnoses in female or elderly patients with vertebral fractures and nephrolithiasis, either symptomatic or asymptomatic, as well as when solitary or multiple osteolytic lesions are encountered on the radiographs.Additionally, a middle aged woman with parathyroid adenoma and subsequent brown tumors detected on the pelvic radiographs is reported. Her initial laboratory findings indicated a minimal increase of the serum calcium, a mild increase of the erythrocyte sedimentation rate, and a significant increase in total serum alkaline phosphatase. Finally, the detection of elevated parathyroid hormone levels indicated the diagnosis of pHPT and necessitated imaging studies of the parathyroid glands, which indicated a parathyroid adenoma. Following successful excision of the parathyroid adenoma, the patient suffered from the hungry bone syndrome. After a follow-up of 20 years, the patient had normal calcium, vitamin D, and parathyroid hormone serum levels, while a pelvic radiograph indicated no significant changes in the appearance of the brown tumors.
Highlights
The purpose of this report is to perform an extensive review of the relevant international literature about primary hyperparathyroidism, to indicate the value of clinical suspicion for the early diagnosis of the disease in a patient presenting in the common orthopaedic practice, and to present an illustrative case with a 20-year follow-up
Hyperparathyroidism (HPT) is due to increased activity of the parathyroid glands either from an intrinsic abnormal change altering excretion of PTH or from an extrinsic abnormal change affecting calcium homeostasis stimulating the production of PTH
It is caused by a solitary parathyroid gland adenoma, usually affecting a single parathyroid gland, in 80-85% of the patients, and in 15-20%, it is associated with all four-gland parathyroid hyperplasia or multiple adenomas in hereditary or familial syndromes, while less than 1% is due to carcinoma
Summary
The purpose of this report is to perform an extensive review of the relevant international literature about primary hyperparathyroidism (pHPT), to indicate the value of clinical suspicion for the early diagnosis of the disease in a patient presenting in the common orthopaedic practice, and to present an illustrative case with a 20-year follow-up
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