PRIMARY HYPERPARATHYROIDISM

PRIMARY HYPERPARATHYROIDISM

The early descriptions of patients with PHPT were dominated by those with osteitis fibrosa cystica. Brown tumours of the long bones and associated subperiosteal bone reabsorption, distal tapering of the clavicles and the classical ‘salt and pepper’ erosions of the skull were typical findings. Over 80% of patients had associated renal stones, significant neuromuscular dysfunction and muscle weakness. This led to the traditional mnemonic that patients with PHPT presented with ‘bones, stones, abdominal groans and psychiatric overtones’. The introduction of the automated serum chemical autoanalyser in the 1970s as well as the radioimmune assay to accurately measure circulating PTH levels radically improved early diagnosis of PHPT , such that the majority of patients are now identified incidentally on routine biochemical investigations and are asymptomatic. The current controversies, therefore, centre on the indications for intervention, either surgically or medically . PRIMARY HYPERPARATHYROIDISM

The early descriptions of patients with PHPT were dominated by those with osteitis fibrosa cystica. Brown tumours of the long bones and associated subperiosteal bone reabsorption, distal tapering of the clavicles and the classical ‘salt and pepper’ erosions of the skull were typical findings. Over 80% of patients had associated renal stones, significant neuromuscular dysfunction and muscle weakness. This led to the traditional mnemonic that patients with PHPT presented with ‘bones, stones, abdominal groans and psychiatric overtones’. The introduction of the automated serum chemical autoanalyser in the 1970s as well as the radioimmune assay to accurately measure circulating PTH levels radically improved early diagnosis of PHPT , such that the majority of patients are now identified incidentally on routine biochemical investigations and are asymptomatic. The current controversies, therefore, centre on the indications for intervention, either surgically or medically .