Hyperparathyroidism

Abstract

Experience with primary parathyroid disease over a 30-year period at the Peter Bent Brigham Hospital and the West Roxbury Veterans Administration Hospital has been reviewed. This consisted of a group of 51 patients of whom 41 had hyperparathyroidism and 10 had incidental adenomas of the parathyroid. Forty-four patients had solitary adenomas, one had multiple adenomas. There were 5 patients with primary hyperplasia, and 1 patient with parathyroid carcinoma in this series. Tabulation has been made as to the age, sex and type of pathology found in these patients, the major clinical manifestations of the disease, and location of the functioning adenoma. Special emphasis has been placed on the aspect of acute parathyroid intoxication. Four patients in this series demonstrated this problem. One of the 4 patients in this group was successfully treated by emergency surgical removal of parathyroid adenomatous tissue; the other 3 did not survive the hypercalcemic crisis. Two of these cases emphasized the point that failure to find the tissue responsible for hypercalcemia resulted in loss of the patient; postoperative survival itself depends on the biochemical rectification attendant upon removal of the hyperfunctioning tissue. One of the 4 was a patient with recurrent carcinoma of the parathyroid. A study has been made of the uninvolved glands in 17 patients with solitary adenomas. The "atrophy" often alluded to has not been uniformly or reliably present.