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Symptomatic Primary Hyperparathyroidism Medical Therapy

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Handbook of Parathyroid Diseases

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Abstract

The oldest published case of primary hyperparathyroidism is a woman who lived in what is now Germany, in the early Neolithic period, around 7,000 years ago [1]. Her skeleton showed pathognomonic skeletal lesions of symptomatic hyperparathyroidism, namely, generalized bone demineralization, scalloping of the phalanges, and “salt pepper” appearance of the skull, and histology revealed enhanced endosteal resorption. In 1948, Albright and Reifenstein described the clinical findings in symptomatic primary hyperparathyroidism dividing them into three categories: those due to bone disease detailed above, those due to diseases of the urinary tract, and those due to hypercalcemia per se [2]. The urinary tract abnormalities include a concentrating defect, nephrolithiasis, and nephrocalcinosis, and clinical findings due to hypercalcemia included loss of muscle tone, constipation, poor appetite, and weight loss [2]. The above classical manifestations of symptomatic hyperparathyroidism, known as the “Bones, Stones, and Moans,” reflected the severity of the hypercalcemia which went undetected until the development of these complications.

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Acknowledgments

The author would like to thank Ms Aida Farha for retrieving articles that were not available online, Mr Ghassan Baliki and Ms Tala Ghalayini for PubMed searches and article retrieval, and Ms Rola El-Rassi for assisting in manuscript preparation. This work was in part supported by an Institutional grant from the American University of Beirut and the Lebanese National Council for Scientific Research.

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Authors and Affiliations

  1. Calcium Metabolism and Osteoporosis Program, WHO Collaborating Center for Metabolic Bone Disorders, Department of Medicine, American University of Beirut-Medical Center, Riad El Solh, Beirut, Lebanon

    Ghada El-Hajj Fuleihan MD, MPH

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  1. Ghada El-Hajj Fuleihan MD, MPH
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Correspondence to Ghada El-Hajj Fuleihan MD, MPH .

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  1. , Dept of Endocrinology and Metabolism, McMaster University, [not given], Hamilton, L8S4L8, Ontario, Canada

    Aliya A. Khan, MD

  2. Mt. Zion Medical Center, Dept. Surgery, University of California, San Francisco, Divisadero St. 1600, San Francisco, 94115, California, USA

    Orlo H. Clark

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Fuleihan, G.EH. (2012). Symptomatic Primary Hyperparathyroidism Medical Therapy. In: Khan, MD, A., Clark, O. (eds) Handbook of Parathyroid Diseases. Springer, Boston, MA. https://doi.org/10.1007/978-1-4614-2164-1_4

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