Musculoskeletal manifestations of primary hyperparathyroidism.
Primary hyperparathyroidism (PHPT) can be associated with a variety of musculoskeletal complaints, which occasionally can be the leading or presenting manifestation. In this paper, we describe the musculoskeletal manifestations observed in patients with primary hyperparathyroidism. Medical record reviews of a select population of 74 patients with primary hyperparathyroidism are seen in a rheumatology practice. Bone manifestations included back pain in 11 patients (15.2 %), generalized bone pain in 7 patients (9.7 %), rib cage/chest pain in 6 (8.3 %), pseudoclubbing in 3, and a giant cell tumor of the mandible in 2 (2.3 %) patients. Articular manifestations such as chondrocalcinosis with or without apatite deposition disease were seen in 13 (17.7 %), arthralgias in 11 (15.2 %), and non-specific synovitis in 7 (9.7 %). Muscle weakness was observed in six patients (8.3 %) and myalgias in three (4.6 %). Less common manifestations such as Achilles tendon rupture, Jaccoud-like arthropathy, sacral insufficiency fracture, arthritis associated with fever of unknown origin (FUO), meningitis, cervical cord compression, and persistent headache were observed in single patients. Musculoskeletal findings are still a frequent and important presentation in patients with primary hyperparathyroidism seen in rheumatology practice. Some of these manifestations can be quite unusual and may represent diagnostic dilemmas to the practicing rheumatologist and/or endocrinologist.
College of Medicine, Drexel University, 414 Downs Drive, Cherry Hill, NJ, 08003, USA. pappur@aol.com.
Ramesh
R
Pappu
Thomas Jefferson University, 233 South Tenth Street, Philadelphia, PA, 19107, USA.
Serge A
SA
Jabbour
Chief Division of Rheumatology, Warren Alpert School of Medicine, Brown University, Providence VAMC, 2 Dudley Street, Suite 370, Providence, RI, 02905, USA.
Anthony M
AM
Reginato
Head Rheumatology Section, Cooper Hospital/University Medical Center, Robert Wood Johnson Medical School, Rutgers University, Camden, NJ, 08103, USA.
Antonio J
AJ
Reginato
D002805:Chondrocalcinosis / Q000097:blood / Q000150:complications / Q000175:diagnosis; D005260:Female; D006801:Humans; D049950:Hyperparathyroidism, Primary / Q000150:complications* / Q000175:diagnosis; D008297:Male; D008875:Middle Aged; D009140:Musculoskeletal Diseases / Q000097:blood / Q000150:complications* / Q000175:diagnosis; D010002:Osteitis Fibrosa Cystica / Q000097:blood / Q000150:complications / Q000175:diagnosis; D010281:Parathyroid Hormone / Q000097:blood; D012219:Rheumatology
D010281:Parathyroid Hormone
And primary hyperparathyroidism; Arthralgias; Arthritis; Chondrocalcinosis; Osteitis fibrosa cystica