Q:

How does primary hyperparathyroidism present?

waelhammad
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2022-11-19
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A young female of 24 years, presents with bony pains and difficulty in walking for 2 years. Her plain radiographs show fractures of right shaft of tibia and fibula and diffuse osteopenia. Screw and plating was seen at right femur for which patient gives a past history of fracture due to trivial trauma 3 years back. Her biochemical parameters reveal serum Ca 13.4 mg/dL, serum phosphorus 1.4 mg/dL, serum creatinine 1.2 mg/dL. Hb is 11.0 g%. 25(OH)D value is 45 ng/dL and her PTH is 108 pg/mL. USG abdomen shows left renal calculus. BMD shows severe osteoporosis. Her past history reveals being treated for 6 months for pulmonary tuber- culosis 4 years back. Her mother expired from non-Hodgkin’s lymphoma 12 years back.

How does primary hyperparathyroidism present?

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waelhammad
2022-11-19
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Central nervous system (CNS)—fatigue, depression, psychosis Neuromusculars—myopathy, pseudogout GIT—constipation, peptic ulcer, GERD, pancreatitis Renal—polyuria, renal stones (Ca oxalate, Ca phosphate), nephrocalcinosis CVS—hypertension, ↓ QT interval, arrhythmias, vascular calcification Skeletal Osteitis fibrosa cystica

↑ osteoclasts in Howship’s lacunae

Brown tumors (hemorrhagic cystic lesions) Subperiosteal resorption

↓ cortical bone density (cancellous bone preserved, especially in spine) Fractures

?Marrow fibrosis Asymptomatic in >50%

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