[Hyperparathyroidism in old age].
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Biomedical subjects
Publications and source records attributed to A S Ignat'ev.
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The paper describes a case history of a 64-year-old woman who had suffered over no less than 2-year period from an unusual hormonally active tumour of the parathyroid gland associated with signs characteristic of Reklinghausen's disease. The tumour presented a node 4 cm in diameter. Histologically it showed pronounced atypia and polymorphism of the cells of the chief cell type and eosinophilic cells. Grimelius silvering revealed not numerous cells with argyrophil granularity in the cytoplasm. No mitoses were detected but tumour cells grew into the capsule of the node. No metastases were found on autopsy 20 days after the operation.
In case when the diagnosis of primary hyperparathyroidism is unclear or difficult to establish the authors recommend to use the method of bone biopsy. The histological picture of the bone in hyperparathyroidism is described. It has been found that the bone biopsy ensures the differenciation of hyperparathyroidism from other forms of osteodistrophies, esteodisplasies and myeloma.
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Under observation were 131 patients with primary hyperparathyroidism, 22 of them (16.8%) suffering its visceral form. Seventeen patients aged from 31 to 60 years. The duration of the disease from the onset of initial signs till establishment of the final diagnosis was from 3 to 21 years. In two-thirds of patients this period lasted from 4 to 7 years. The clinical picture of the disease is described. All patients were subjected to surgical therapy--adenomas were removed in 18 patients, hyperplastic bodies --in 3, parathyroid cancer--in 1. No lethal issues were observed. The follow-up terms were from 1 to 7 years.
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Under observation were 66 (50.3%) of 130 patients with an ossific form of hyperparathyroidism. Fourty five patients showed the classical picture of Recklinghausen disease, and 21-only diffuse osteoporosis. The correct diagnosis would be established 4-5 years following the onset of the disease. During the period of most distinct manifestations pains in bones were noted in 93 per cent of cases. Two thirds of patients showed marked atonia and fatigue. Pathological fractures were multiple and were observed in 45 of 66 patients (totally 125 fractures). Great importance in establishing the diagnosis of the form of hyperparathroidism is attached to roentgenological investigation of all bones and biochemical assay of blood and urine.
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