This paper presents a report of two cases of hyperparathyroidism treated surgically and confirmed
pahhologically during the period from February 1961 to August 1971 at Presbyterian Medical Center
(here after called PMC), Choun Ju, Korea. Histologically, one cases had a double parathyroid neoplasm, one
a Carcinoma and the other an adenome; and the other case proved to be a single parathyoid adenoma.
Both cases have sustained complete clinical cure, remining asymptomatic for 10 years and 8 months , and
6 years have been reported; two cases of hyperparathyroidism among American patients were reported by
Park¹.
Recently, various newer diagnostic procedures have made it possible to discover hyperparathyroidism
among entirely aympotomaic patients. The most important of these is blood chemistry screening employing
the multiple serum analyzer (i.e. SMA 12 Technicon. Inc)². The literature has been reviewed with
regard to etiology, clinical manifestations, the lifethreatening complication of acute hyperparathyroid crisis,
diagnosis and surgical principles.
CASEⅠ:
Chu K.D. Female 29 y.o. Hospital #L-427
This 29 year old primipara was admitted to surgical Dept. of PMC on January 22, 1962 under the
imression of hyperparathyroidism. She had complaints of swelling, pain and tenderness in the medical
aspect of the Lt. lower leg for about 3 months prior to admission. Since 2 months after onset, she had
noted fever and chills, painful swelling and tenderness on both sides the middle third of the legs. Othe
rwise, were not remarkable.
Bone surveys revealed the following:
1. Generalized decalcification of bone.
2. Vertebral collapse (L Ⅰ-4)
3. Subperiosteal resorption of phalanges and lamina dura surrounding the teeth, but no evidence of
calcification.
Initial labaratory findings:
Hgb. 12gm%; Htc. 35; WBC 6,550 with differential counts of Seg. 69%, Eos. 1%, Lymph. 30
% and normal RBC; serum calcium, 17 to 18 ㎎%; serum phosphorus 3.7㎎% to 5㎎%; alka
line phosphatase 39.5 Bodansky unit; and positive Sulkowitch test.
On February 7, 1962, the neck was explored, four parathyroid were identified, and two parathyroid
tumors were found and frozen section was done. The right upper parathyroid tumor was an adenoma
measuring 1×2×2㎝, in size, a firm mass imbedded in thyroid tissue. The right lower parathyroid
proved to be a low grade Carcinoma which measured 2.5×2.5×2㎝. an in appearance was cystic brown
mass. Resection of right parathyroid and right thyroid lobectomy was performed.
Post operative tetany was controlled with calcium lactate 4 to 6 gm. daily. The patient was discha
rged with a body cast and calcium lactate, on the postoperative 14 th. day. The final pathologic diagnosis
was chief cell adenoma of superior parathyroid and low grade carcinoma of inferior parathyroid.
One month after discharge, the Pain in the left tibial area had subsided and she could move her extr
emities more easily. However, bilateral carpopedal spasm and positive Chvosteck sign still were present.
Three months after surgery (May 14, 1965): The patient felt much better, and Muscular spasm had
disappeared completely. Serum calcium was 9㎎% and phosphorus was 4.28㎎%. Sulkowitch test
was negative and the alkaline phopatase value was 9.3 Bodansky units.
10 years and 8 months after surgery (August 21, 1971): The patient has been leading a normal life,
and reported that she delivered a son in her postoperative 5th. year. No evidence of tumor recurrence
has been noted.
CASE Ⅱ:
Kim J.S. Male 17. y.o. Hospital #O-2664.
This 17 year old male was brought to PMC with chief complaints of progressive weakness of all
extremities and difficulty in walking present from about 1½years previously. He was admitted on
May 3, 1965 under the impression of hyperparathyroidism.
On physical examination, body temperature was 100℉, pulse rate 79/min, and weight 75lbs. General
appearance revealed a boy whose body build was underdeveloped for his age. A mass of 4㎝. in size in
the left side of the neck was palpable. Chest wall appeared asymetrical and costochondral junction was
hypertrophied. Extremities revealed decreased muscle tonus, and there was diffuse muscle atropht, espe
cially in the lower extremities. Clubbinh of the fingers and enlargement of metaphyses of the wrists,
ankles, elbows, and knee joints were noted.
Initial laboratory finginds:
The Hgb. was 14.5gm%, the WBC 10,050 and urinalysis cloudy alkaline urine. Occasi
onal calcium phosphate and calcium oxalate crystals were present. Serim calcium varied from 13.8 ㎎
% to 14.6㎎%. Serum phosphorus was 3.0㎎%, alkaline phosphatase 26.6 Bodansky units, BUN
6.1㎎%, and Sulkowitch test was positive.
Roentgenological bone survet revealed very severe demineralization, cortical spurring, and osteoporosis
most conspicuous at the metaphyseal portion of the diaphysis. The typical lacy pattern of the pgalanges
was noted in roentgenogram of the hands. No evidence of renal cacification was noted.
On May 7, 1965, the neck was explored and the four parathyroids were identified. A single adenoma
was removed from the Lt. upper parathyroid after frozen section confirmation. The adenoma was a
brownish or tan colored 1-obulated tumor measuring 3.5×3.5×2㎝, in size and 13 gm, in weight.
Post operative clinical course:
On the first post operative day, the serum calcium dropped down to 7.8 ㎎%, and transient te
tany developed. Calcium phosphate was administered in doses of 2 gm daily with improvement. On the
11th postoperative day, he was discharged; at that time he was stil experiencing difficulty in walking,
numbness, and paresthesia.
Follow up:
One and a half months after operation (6-23-65):
The patient was able to walk well and had recovered his grasping power.
Postoperative 3 months (8-10-65): The patient was well and active.
No further tetany had occurred.
6 years and 3 months after surgery (8-21-71): The patient enjoys normal life.
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