MUSCOSKELETAL
MANIFESTATIONS IN PRIMARY HYPERPARATHYROIDISM
Skeleton is
a typical target organ in primary hyperparathyroidism (PHPT) and
musculoskeletal complaints may be the leading or presenting manifestation.
Currently, most cases of PHPT are diagnosed in asymptomatic patients
(asymptomatic PHPT), typically during routine biochemical testing revealing
hypercalcemia. Thus, nowadays, diagnosis of PHPT is established in earlier
stages of the disease; as a result, in current clinical practice bone
involvement is milder. In contrast, in the past, when PHPT was diagnosed at a
more advanced stage, following a more protracted clinical course, bone disease
was much more severe, manifested as osteitis fibrosa cystica. This clinical
entity is rarely seen today in patients with PHPT, but remains a significant
problem in patients with chronic renal failure and secondary
hyperparathyroidism (“renal’ hyperparathyroidism). Typical skeletal
manifestations in PHPT includes bone/joint pain and pathological fractures.
Other potential musculoskeletal manifestations in more advanced cases include muscle
weakness due to muscle atrophy and hyperreflexia. In less severe PHPT or in
disease of short duration, bone loss is documented based on findings of modern
imaging, in the absence of symptoms; however, pathologic fracture is still a
possible initial manifestation, even in these asymptomatic patients. Fracture risk
is increased at both non-vertebral (predominantly cortical) as well as
vertebral (trabecular) sites. Advanced age and female gender are risk factors
for pathologic fractures in PHPT. More vague musculoskeletal manifestations in
PHPT include back pain, generalized bone pain, rib cage/chest pain,
chondrocalcinosis, arthralgias, non-specific synovitis, myalgias, and more
rarely Achilles tendon rupture, arthritis associated with fever of unknown
origin etc. These manifestations are more unusual and may represent diagnostic
dilemmas for the practicing clinician.
Σχόλια
Δημοσίευση σχολίου