Observations Regarding the Prognosis and Diagnosis of Hyperparathyroidism*
THE material consists of 31 cases observed during the period 1930 to 1952. Of these, 28 were operated upon; one was subjected to roentgen therapy only, and two received no treatment. Eighty-five per cent of the patients were women. Renal calcifications or concrements without visible bone changes occurred in 45 per cent. With or without concomitant skeletal changes renal calcifications appeared in 74 per cent. A single ureter stone can be the first symptom in hyper-parathyroidism. Of great importance is the fact that hyperparathyroidism may be present, although there are other factors to explain the development of calculi. Thus among 31 patients, three were treated many years for chronic staphylococcuria with stone formation and underwent several operations before the hyperparathyroidism was diagnosed.
Less often appreciated than renal calcification, but probably of greater significance from the prognostic viewpoint, are the renal changes, which, though not detectable radiologically, appear in all cases of hyperparathyroidism and lead to a more or less severe reduction in renal function. The kidney damage chiefly manifests itself in a reduced concentrating power, while in the beginning the nonprotein nitrogen may be normal, the clearance good, and the urine albumin-free. Table 1 shows the mean values for nonprotein nitrogen, the clearance and the water test in the cases I observed.
In assessing the prognosis, the renal changes play a much greater part than the altered bone structure. Even a severe generalized osteitis fibrosa cystica can disappear functionally after a parathyroidectomy. Although the hyperparathyroidism disappears, kidney damage often persists . . .