X-ray Therapy of Hyperparathyroidism

Abstract

THE relationship between the parathyroid glands and osteitis fibrosa cystica is well recognized. This subject was thoroughly presented by Merritt and Lattman (1) at the Annual Meeting of this Society in Detroit, in 1935, together with a review of the literature and case reports. Shelling (2), in his admirable treatise, “Parathyroids in Health and in Disease,” classifies hyperparathyroidism into three clinical types: (a) classical form in which the lesions of osteitis fibrosa cystica predominate; (b) osteoporotic form in which the decalcification of the skeleton is generalized and no tendency toward cyst or giant-cell formation is present, and (c) metastatic form in which the chief symptoms are associated with calcium deposition in the soft tissues, especially the kidneys, where it occurs in the form of calcinosis or of calculi. The fundamental pathologic process in hyperparathyroidism is osteoporosis. Quoting from Shelling (2): “It differs from senile osteoporosis and from atrophy due to disuse in that in the latter instances the thinned compact and spongy bone is rarely replaced by fibrous tissue, whereas in hyperparathyroidism the resorptive and reparative processes are characterized by the presence of fibrous tissue in place of the original bone and marrow spaces; by the abundance of osteoclasts and by the presence of resorbed and newly formed bone. Some of the areas of fibrous connective tissue contain immature bone, others newly formed bone which merges with the original bone, and still others show no evidence whatsoever of new bone formation. In the fibrous areas which are free of bone tissue and which are often present subperiosteally, multinucleated giant cells and extravasated blood may be seen.” The aforementioned pathologic process occurring in the vertebral column produces a decalcification and collapse of the bodies, as a result of which the intervertebral discs expand into the cancellous bone, producing the so-called “fish-tail” spine. The end-result is a marked kyphosis, scoliosis, or both, associated with shortening of the stature and deformity of the thoracic cage which, in turn, alters the normal relationship of both the thoracic and abdominal viscera. This presentation will be limited to a discussion of the spinal osteoporotic type and the symptom-complex resulting therefrom. Clinically this form occurs most frequently in women past the menopausal age. The chief complaint is intense pain in the back, which is constant, is aggravated by motion, and often becomes worse when the patient is in the reclining position. Associated with this is a profound asthenia and some loss in weight. These symptoms have usually existed over a period of several years. Associated with these are often vague gastric and cardiac symptoms resulting from the disturbed visceral relationships produced by the kyphosis, scoliosis, and vertebral collapse. The blood picture is that of a mild secondary anemia.