Review on January 12, 2010
This is a review of a premenopausal woman who was experiencing some unexplainable symptoms. She was taken to the hospital where her medical history was reviewed and she underwent tests to better understand the cause of her symptoms. She was known to have osteoporosis and acute primary hyperparathyroidism. This article reviews the outcome of the premenopausal woman after she underwent a parathyroidectomy.
Patients with primary hyperparathyroidism experience symptoms of fatigue, depression, and poor memory in association with serum parathyroid hormone levels. Primary hyperparathyroidism is a disorder that affects more women than men, usually during the first ten years after menopause. Acute primary hyperparathyroidism however presents more severe symptoms and life threatening hypocalcaemia. Since only 48 cases were reported in a 13 year time span ( 1974 – 1987 ), this condition is considered extremely rare.
Osteopenia is often found in patients with have primary hyperparathyroidism. Osteopenia is a condition in which bone mineral density is lower it should be, affecting the hip more than the spine. Some consider it a precursor to osteoporosis but not all patients with osteopenia will develop osteoporosis.
Currently doctors are not sure whether patients with primary hyperparathyroidism will show improvement in osteopenia after undergoing a successful parathyroid surgery. This premenopausal woman that had acute primary hyperparathyroidism and severe osteoporosis showed a dramatic improvement of body mass index after undergoing a successful parathyroidectomy.
The 37 – year – old premenopausal women described symptoms of fatigue, bone pain, slowed mentation, depression, decreased appetite, nausea, constipation and weight loss. Yet no physician could identify the cause of her symptoms.
At admission her serum sodium, potassium, chloride and carbon dioxide as well as hormone levels were tested. She underwent a neck biopsy upon which three parathyroid glands were found normal. She was also given oral calcium and ergocalciferol therapy. Her bone density was measure at her neck and her spine using a dual energy x-ray.
The premenopausal woman was told to maintain her calcium and vitamin D regimen and do exercise daily. A year after the bone densitometry was performed the patient showed dramatic improvement.
Eventually the patient began to notice a slow improvement in her energy and a decrease of bone pain.
This study may be an indicator that solves a bit of the controversy concerning the effect of parathyroidectomy for osteoporosis. The premenopausal woman that was tested showed a drastic improvement.