Abstract
Primary hyperparathyroidism (PHPT) can be associated with a variety of musculoskeletal complaints, which occasionally can be the leading or presenting manifestation. In this paper, we describe the musculoskeletal manifestations observed in patients with primary hyperparathyroidism. Medical record reviews of a select population of 74 patients with primary hyperparathyroidism are seen in a rheumatology practice. Bone manifestations included back pain in 11 patients (15.2 %), generalized bone pain in 7 patients (9.7 %), rib cage/chest pain in 6 (8.3 %), pseudoclubbing in 3, and a giant cell tumor of the mandible in 2 (2.3 %) patients. Articular manifestations such as chondrocalcinosis with or without apatite deposition disease were seen in 13 (17.7 %), arthralgias in 11 (15.2 %), and non-specific synovitis in 7 (9.7 %). Muscle weakness was observed in six patients (8.3 %) and myalgias in three (4.6 %). Less common manifestations such as Achilles tendon rupture, Jaccoud-like arthropathy, sacral insufficiency fracture, arthritis associated with fever of unknown origin (FUO), meningitis, cervical cord compression, and persistent headache were observed in single patients. Musculoskeletal findings are still a frequent and important presentation in patients with primary hyperparathyroidism seen in rheumatology practice. Some of these manifestations can be quite unusual and may represent diagnostic dilemmas to the practicing rheumatologist and/or endocrinologist.
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References
Silverberg SJ, Fitzpatrick LA, Bilezikian JP (1995). Hyperparathyroidism. Principles and Practice of Endocrinology and Metabolism: 512–519
Bilezikian JP (1996). Primary hyperparathyroidism. Primer on the Metabolic Bone Diseases and Disorders of Mineral Metabolism.:181–186.
Bhalla AK (1986) Musculoskeletal manifestations of primary hyperparathyroidism. Clinics Rheum Dis 12:691–705
Mallette LE, Bilezikian JP, Heath DA, Aurbach GD (1974) Primary hyperparathyroidism: clinical and biochemical features. Medicine 53:127–146
Potts JT Jr (1998) Primary hyperparathyroidism. Metabolic Bone Disease:419–423
Heath H III, Hodgson SF, Kennedy MA (1980) Primary hyperparathyroidism: incidence, morbidity, and potential economic impact in a community. N Engl J Med 302:189
Gasser RW (2013) Clinical aspects of primary hyperparathyroidism: clinical manifestations, diagnosis, and therapy. Wien Med Wochenschr 163:397–402
Parkum IM, Estherhuizen TM, Maharaj S, Pirie FJ, Motala AA (2013) Characteristics, management and outcome of primary hyperparathyroidism in South Africa: a single-centre experience. Posstgrad Med J 89:626–631
Berson SA, Yalow RS, Aurbach GD, Potts JT Jr (1963) Immunoassay of bovine and human parathyroid hormone. Proc Natl Sci USA 49:613–617
Bringhurst FR, Demay MB, Kronenberg HM (1998). Hypercalcemic disorders. Williams Rextbook of Endocrinology:1172–1179.
Deng XL, Liu XY, Ning XU (2009) Comparative study of low back pain misdiagnosed as spondyloarthropathy. Clin Rheumatol 28:893–898
Ferrari R, Russell A (2015) Prevalence of primary hyperparathyroidism in a referred sample of fibromyalgia patients. Clin Rheumatol 34:1279–1283
Yashiro T, Okamoto T, Tanaka R, Ito K, Hara H, Yamashita T et al (1991) Prevalence of chondrocalcinosis in patients with primary hyperparathyroidism in Japan. Endocrinol Japon 38:457–464
Thomas E, Leroux JL, Serre I, Bonnel F, Mary H, Baldet P et al (1995) Tophaceous gout of the patella with primary hyperparathyroidism. Clin Exp Rheumatol 13:263–265
Chou FF, Sheen-Chen SM, Leong CP (1995) Neuromuscular recovery after parathyroidectomy in primary hyperparathyroidism. Surgery 117:18–25
Sarda A, Arunabh VM, Kapur M (1993) Paraplegia due to osteitis fibrosa secondary to primary hyperparathyroidism: report of a case. Japan J Surg 23:1003–1005
Teh BT, Farnebo F, Kristofferson U, Sundelin B, Cardinal J, Axelson R et al (1996) Autosomal dominant primary hyperparathyroidism and jaw tumor syndrome associated with renal hamartomas and cystic kidney disease. JCEM 81:4204–4211
Bell E, Lorimer AR, Hinnie J (1994) Association between myotonic dystrophy and primary hyperparathyroidism. J of Inter Medl Res 22:296–298
Inoue H, Miki H, Oshimo K, Tanaka K, Monden Y, Yamamoto A et al (1995) Familial hyperparathyroidism associated with jaw fibroma: case report and literature review. Clinical Endocrinol 43:225–229
Barzilay J, Rolla AR (1992) Erosive spondyloarthropathy in primary hyperparathyroidism without renal failure. Am J Kidney Dis;XX:90–93
Borg EJT, Eggelmijer F, Jaspers PJTM, Slee PHTJ (1995) Milwaukee shoulder associated with primary hyperparathyroidism. J Rheumatol 22:561–562
Barlow IW, Archer IA (1993) Brown tumor of the cervical spine. Spine 18:936–937
Joyce JM, Idea RJ, Grossman SJ, Liss RG, Lyons JB (1994) Multiple brown tumors in unsuspected primary hyperparathyroidism mimicking metastatic disease on radiograph and bone scan. Clin Nucl Med 19:630–635
Motateanu M, Deruaz JP, Fankhauser H (1994) Spinal tumor due to primary hyperparathyroidism causing sciatica: case report. Neuroradiology 36:134–136
Taccari E, Spadaro A, Sorgi ML, Scavalli AS (1992) Sacroiliac joint involvement in primary hyperparathyroidism: pathogenetic considerations. Clin Exp Rheumatol 10:263–265
Silverberg SJ, Locker FG, Bilezikian JP (1996) Vertebral osteopenia: a new indication for surgery in primary hyperparathyroidism. JCEM 81:4007–4012
Peacock M (1991) Interpretation of bone mass determinations as they relate to fracture: implications for asymptomatic primary hyperparathyroidism. J Bone Mineral Res 6:S77–S82
Vogel M, Hahn M, Delling G (1995) Trabecular bone structure in patients with primary hyperparathyroidism. Virchows Arch 426:127–134
Wilczek H, Kanka J (1993) Coincidence of Paget disease of bone and primary hyperparathyroidism. Sbornik Lekarsky 94(3):213–217
Blinder G, Hiller N, Matas M, Gatt N, Shilo S (1997) Brown tumor in the cricoid cartilage: an unusual manifestation of primary hyperparathyroidism. Ann Otol Rhinol Laryngol 106:252–253
Lamba PS, Bhansali A, Muralidharan R, Katariya RN, Dash RJ (1993) Primary hyperparathyroidism in an adolescent girl manifesting as rickets. JAPI 41:533–534
Shah VN, SK B, A B, A B, BR M, V B (2012) Influence of age and gender on presentation of symptomatic primary hyperparathyroidism. J Postgrad Med 58:07–11
Li JKY, Chow CC, Yeung VTF, Ko GTC, Metreweli C, Cockram CS (1996) Primary hyperparathyroidism complicated by osteomalacia. Ann Clin Biochem 33:571–574
Bywaters EGL, Dixon AJ, Scott JT (1963) Joint lesions of hyperparathyroidism. Ann Rheum Dis 22:171–187
Dodds WJ, Steinbach HL (1968) Primary hyperparathyroidism and articular cartilage calcification. Am J f Roent, Radium Therapy Nuclear Medicine 104:884–892
Genant HK, Heck LL, Lanzi LH, Rossman K, Horst VH, Paloyan E (1973) Primary hyperparathyroidism. A comprehensive study of clinical, biochemical and radiographic manifestations. Radiology 109:513–524
Glass JS, Grahame R (1976) Chondrocalcinosis after parathyroidectomy. Ann Rheum Diseases 35:521–525
Pritchard MH, Jessop JD (1977) Chondrocalcinosis in primary hyperparathyroidism. Influence of age, metabolic bone disease and parathyroidectomy. Ann Rheum Dis 36:146–151
Rynes RI, Merzig EG (1978) Calcium pyrophosphate crystal deposition disease and hyperparathyroidism. A controlled, prospective study. J Rheumatol 5:460–468
Bilezikian JP, Aurback CD, Connor TB, Pachas WN, Aptekar R, Wells SA et al (1973) Pseudogout after parathyroidectomy. Lancet 3:445–446
O’Duffy JD (1976) Clinical studies of acute pseudogout attacks: comments on prevalence, predispositions and treatment. Arthritis Rheum 19:349–352
Currey HLF, Key JJ, Mason RM, Swettenham KV (1966) Significance of radiological calcification of joint cartilage. Anns Rheum Dis 22:22–28
McCarty DJ Jr (1972) Pseudogout: articular and chondrocalcinosis, calcium pyrophosphate crystal deposition disease. Arthritis and Allied Conditions, 8th ed.:1140–1160.
McCarty DJ, Silcox DC, Coe F, Jacobelli S, Reiss E, Genant H et al (1974) Diseases associated with calcium pyrophosphate dihydrate crystal deposition. Am J Med 56:704–714
Grahame R, Sutor DJ, Mitchener MB (1971) Crystal deposits in hyperparathyroidism. Ann Rheum Dis 30:597–604
Lipson RL, Williams LE (1968) The connective tissue disorder of hyperparathyroidism. Arthritis Rheum 11:198–202
Bandeira F, Griz L, Caldas G, Macedo G, Bandeira C (1998) Characteristics of primary hyperparathyroidism in one institution in Northeast Brazil. Bone:S380
Silverberg S, Shane E, Jacobs T, Siris E, Bilezikian J (1999) A 10-year prospective study of primary hyperparathyroidism with or without surgery. N Engl J Med 341:1249–1255
Bilezikian J, Brandi M, Eastell R, Silverberg S et al (2014) Guidelines for the management of asymptomatic primary hyperparathyroidism: summary statement of the 4th International Workshop. J Clin Endocrin Metab 99:3561–3569
Parisien M, Silverberg S, Shane E et al (1990) The Histomorphometry of bone in primary hyperparathyroidism: preservation of cancellous bone structure. J Clin End Met 70:930–937
Abdelhadi M, Noedenstrom J (1998) Bone mineral recovery after parathyroidectomy in patients with primary and renal hyperparathyroidism. J f Clin End Met 83:3845–3850
Shane E, Bilezikian JP (1982) Parathyroid carcinoma: a review of 62 patients. Endocrin Rev 3:218–226
Ricci J, Vlasschaert J, Salit IE (1984) Prolonged fever associated with primary hyperparathyroidism. Can Med Assoc J 131:459–460
Blair DC (1979) Primary hyperparathyroidism presenting as fever of unknown origin with unremitting headache. Ann Intern Med 91:575–576
Edwards GA, Daum SM (1959) Increased spinal fluid protein in hyperparathyroidism and other hypercalcemic states. Arch Intern Med 104:29–36
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The authors thank Ms. Deborah Donato-Checa for her time and effort to prepare this manuscript.
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It is also understood that Dr. Antonio J. Reginato (now deceased) had approval from the ethical committees where these human studies were conducted and consented all the patients prior to inclusion in the study.
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Antonio J. Reginato is deceased on May 2004
An erratum to this article is available at http://dx.doi.org/10.1007/s10067-016-3531-3.
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Pappu, R., Jabbour, S.A., Regianto, A.M. et al. Musculoskeletal manifestations of primary hyperparathyroidism. Clin Rheumatol 35, 3081–3087 (2016). https://doi.org/10.1007/s10067-016-3450-3
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DOI: https://doi.org/10.1007/s10067-016-3450-3