Clinical profile of 128 subjects operated for primary hyperparathyroidism

From 1960 to 1990, one hundred twenty eight (128) subjects with primary hyperparathyroidism were operated in the University Hospital. The medical records were reviewed. Serum and urine chemistries were done by conventional methods, serum PTH was done by RIA's (N-, C-, and midregion) and intact by IRMA and 1,25 dihydroxycholecalciferol by a non equilibrium receptor assay from calf thymus and preceded by double Sep-Pak chromatography. The distal third of the radius (nondominant arm) was used to evaluate radial bone density (RBD), using single photon absorptiometry (Norland) and the lumbar bone density (LBD) was measured by dual energy X Ray absorptiometry (DEXA). The RBD was done in 41 females and 15 males and the LBD in 12 females and 4 males. The series comprised 95 females, age range from 15 to 79 years, and 33 males, age range from 14 to 69 years. Prominent clinical features included nephrolithiasis in 72 subjects (56 per cent), osteitis fibrosa cystica in 2, isolated familial hyperparathyroidism in 4 subjects in one family, 7 subjects with MEN-1 in 3 families, and 4 subjects with MEN-2 in one family. Only 7 subjects were asymptomatic. Serum calcium was elevated in all, serum alkaline phosphatase was elevated in 24 per cent and urinary hydroxiproline was increased in 48 per cent. Serum phosphorus was low in 92 per cent. PTH assay was either elevated or inappropriately normal for the serum calcium in all patients tested. Serum 1,25 D was elevated in 57 per cent. The PTH level was positively correlated with the serum calcium (r = 0.70), but had no significant correlation with the serum phosphorus and the 1,25 D. The RBD expressed as the standard deviation from that of the mean for age and sex matched controls was > or = 2 SD below the mean in 39 per cent of females and in 40 per cent of males. In contrast to the RBD none of the subjects tested had a LBD > or = 2 SD below the age and sex adjusted mean. 103 subjects had adenomas, 20 primary hyperplasia, 2 carcinomas and in 3 surgical exploration was unsuccessful. As to the outcome of Surgery, 117 (93 per cent) were cured. Thus, in this series, successful surgery for primary hyperparathyroidism is the rule. Primary hyperparathroidism is rarely asymptomatic and appendicular bone disease and nephrolithiasis are commonly seen.

The lumbar and femoral bone mineral densities in a normal female Puerto Rican population

The aim of this study was to establish the reference values of the bone mineral density (BMD) of the lumbar spine and the proximal femur in a normal adult female Puerto Rican population. In the selection of the population, exclusion criteria included diseases, use of drugs and toxic habits (smoking and alcoholism)known to affect bone and mineral metabolism. The study population comprised 131 healthy females, ages 20 to 69 years. Spinal radiographs were taken of women age 60 or more to exclude spinal defects or artifacts. The bone mineral densities were measured using the dual energy X Ray absorptiometer (DEXA, Hologic model 1000). The peak BMD was found in the lumbar spine at the age 30 to 39 years and at the age 20 to 29 years in the femoral neck, trochanter and Ward's triangle. The decrease in BMD from peak values to those at age 60 to 69 years were 18 per cent for the lumbar spine, 16.3 percent for the femoral neck, 30.1 percent for the Ward's triangle and 12.4 percent for the trochanter. The major fall in the BMD was related to the menopause and compares with that of other series. There was no statistical difference from Hologic reference values in a mixed population of the USA