Development of diagnostic method and increasing interest in primary hyperparathyroidism have led to reports of many of such cases over last 30 years. Inasmuch as severe complications, including bone changes, of primary hyperparathyroidism are completely reversed by resection of the diseased parathyroid gland, it is of prime importance to diagnose the disease precisely. In Korea only 4 cases have been reported. In order, to arouse more interest in this disease, we report the 5th case of hyperparathyroidism which was diagnosed mainly by electrolyte changes of the serum and urine, and by excluding other diseases. A parathyroid adenoma was successfully removed.
The patient was a 36 year old single woman, who was admitted to the hospital because of pain on the extremities. 5 years prior. to entry, pain developed in the lower portion of the left chest, which spread to all the extremities. On admission, there was pain on motion of both shoulders and hip joints. No mass was palpable in the thyroid area. The serum calcium was 12.6 m/dl, the phosphate 1.2 mg/dl, and the alkaline phosphatase 9.6 Bodansky units. Urinary calcium was 280 mg and the phosphate 504 mg per 24 hours. Bone series revealed generalized demineralization of the bone, subperiosteal bone resorption of the clavicles and loss of the laminae dura of the teeth. On operation. a mass; 1.5 X 1.5 X 1.0 cm in size, was found in the lower pole of the right lobe of the thyroid which was, later, found to be parathyroid adenoma of chief cell type. After resection of the adenoma, serum calcium fell down to 7.4 g per dl. She was maintained on 10 g of calcium and 200,000 units of vitamin D3 daily. Two weeks after the operation, serum calcium returned to the norma1 range and the extremity pain ameliorated. X-ray film taken on 40th hospital day revealed considerable improvement of the bone lesion.
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