Endocrine Abstracts

Primary hyperparathyroidism is an autonomous form of hyperparathyroidism, whose characteristics are: increased secretion of parathyroid hormone with clinical signs of hypercalcemic syndrome and various organ lesions, including bones.

Case report: A 51-year-old Caucasian female presented with walking difficulties, polyuria, polydipsia, palpitations and headaches. Examination showed thoracic spine hyperkyphosis with consecutive chest deformity, staggered walk, loose teeth and severe periodontal disease. Using basic diagnostic procedures the diagnosis of primary hyperparathyroidism (total serum calcium: 2.62 mmol/l, phosphorus: 0.51 mmol/l, PTH: 1721 pg/ml) with dominant bone lesions in the form of cystic von Recklinghausen osteodystrophy was made. Kidneys and gastrointestinal tract were intact. Hand X-ray showed marked diffuse osteoporosis with reduction of bone elements; edge defects due to lacunar resorption of corticalis dominantly in the middle phalanges; bone fractures; thinner ungvicular extensions; ‘bubble’ structure due to group of cysts with thin septa predominantly on the V metacarpal bone, giving the look of bone inflates; the presence of brown tumors. Primary hyperparathyroidism was treated surgically (adenoma of left inferior parathyroid gland). Calcium and vitamin D supplementation was administered until correction of hypocalcaemia with normalization of PTH levels. X-ray of hands 7 months after the initiation of therapy: reparative changes were dominant with phalangeal deformities and hyperostosis. Hand X-ray 20 months later: filling of bone defects is complete, reduced inflates of V metacarpal bone, the picture of old fractures with mild bone deformities, gradual reduction of periostal lacunar resorptions with sclerotic margins, osteoporosis. Hand X-ray after 6 years: marked diffuse osteoporosis; inflates of V metacarpal bone with anarchic distribution of bone elements and thinner corticalis, small pseudo cystic attenuation. Other earlier seen changes are not present.

Conclusion: The restitution of severe bone lesions in primary hyperparathyroidism may take several years after successful surgery.