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[Primary hyperparathyroidism. History].

Rev Rhum Mal Osteoartic

May 1988

Service de Rhumatologie, Hôpital Adolphe de Rothschild, Paris.

The term primary hyperparathyroidism currently refers to the clinical and biological manifestations resulting from the hypersecretion of parathyroid hormone by one or several parathyroid adenomas. This entity is a recent one since it goes back to 1925. The clinical picture resulting from this anomaly, were first described as Recklinghausen's fibrous osteitis, which was not justified since Recklinghausen had not established the relationship between the clinical manifestations and the adenoma discovered by Mandl, then under the name of parathyroid osteosis.

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A 73-year-old woman with severe, old standing thyrotoxicosis developed osteosis with deformities of the lower limbs and spine resembling osteomalacia. All the well-known radiological, and histomorphometric features of thyroid osteosis were caricaturally present in this patient who, in addition, exhibited curvatures of the lower limbs that are exceptionally described in hyperthyroidism. A study of standard phosphorus/calcium values, 25 OH D values, circulating parathyroid hormone levels and fractional absorption of 47Ca before and after thyroidectomy enables the authors to discuss the current pathophysiological concepts concerning phosphorus/calcium and bone metabolism in hyperthyroid conditions.

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The authors present two unusual operative findings during surgery for stapedo-vestibular ankylosis, of which no similar cases would appear to be found in the literature. The first case posed the problem of stapedo-vestibular ankylosis as a sequel of clinically latent otitis, the only manifestations of which were radiological opacity of the mastoid and an area of osteitis of the promontory, still active, in the absence of any other progressive inflammatory phenomena or sequelae. Surgery required curettage and opening of the promontory, associated with total stapedectomy and a Teflon-inter-position.

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