Diagnosis of Obscure Hyperparathyroidism

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Much has been written concerning the overt clinical features of hyperparathyroidism and, when the condition leads to osteitis fibrosa cystica and renal calculi, it is easily recognized. It is not the purpose of this article to re-emphasize the classical clinical findings in cases of this type, but to call attention to some of the more unusual manifestations of the condition and to present some practical considerations which may be of value in the recognition of the less typical hyperparathyroidism.

The classical blood chemical alterations of hyperparathyroidism are hypophosphatemia and hypercalcemia, the latter due to elevation in the ionic calcium fraction of the serum. Two case reports presenting factors which obscure the existence of these alterations are presented.

Case Reports

Case 1. A college professor 32 years of age presented a history of recurrent right and left renal calculi for over a period of 1 year. The initial stone, removed from the left renal pelvis 1 month after onset of illness, was composed of calcium phosphate. Two small stones in the right renal pelvis were visualized by x-ray and at the time of initial operation were observed to have increased in size. In the left kidney a second large calculus appeared shortly after the nephrolithotomy; several others had been passed. Progressive fatigue had been apparent for a period of 2 years. Pain was experienced at times in the back, the shoulders, and knees. The fingernails had become “shabby.” No polydipsia, polyuria or nocturia had been noted.

Studies by Dr. Charles A. . .



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