Case Report: Chronic Unclassified Polyarthritis: A Rare Presentation of Primary Hyperparathyroidism
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- Category: Vol. 84, June 2016
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Case Report: Chronic Unclassified Polyarthritis: A Rare Presentation of Primary Hyperparathyroidism, ABDULRAHMAN A. AL-DURAYWISH
Abstract
Background: Primary Hyperparathyroidism (PHPT) is the predominant cause of hypercalcemia. The commonest cause of PHPT is parathyroid adenoma (85%) along with parathyroid hyperplasia or carcinoma. The asymptomatic disease could manifest with different and protean symptoms including neuromuscular and neuropsychiatric symptoms. The delayed diagnosis allows bony lesions to progress to osteitis fibrosa cystica and brown tumor.
Case Description: An unusual case of PHPT presented with unclassified chronic polyarthritis for 18 months. The condition was associated with history of recurrent renal stones. Due to improper history taking, lack of routine screening for serum calcium and incompliance of the patient, the diagnosis of PHPT was delayed till osteitis fibrosa cystica occurred. Following admission to hospital for assessment of his arthritic illness, diagnosis of PHPT due to parathyroid adenoma was made. Right hemi-thyroidectomy with excision of the right superior and inferior parathyroid glands was done. Two-years follow-up revealed dramatic improvement after surgery.
Conclusion: Proper history taking, high index of suspicion and routine chemistry investigations could enable early diag-nosis of PHPT. Patients with unclassified arthritis should be screened for the possibility of PTH excess or hypercalcemia to exclude hyperparathyroidism.