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December, 1945 PARATHYROID ADENOMA—HANES 509 Fig. 1. Showing the characteristic delicate mottling due to calcification in the pyramids of the kidney (nephrocalcinosis). cium and phosphorus metabolism. This discovery threw a new light upon the metabolic functions of the parathyroids, and in 1924 Collip and others prepared an extract of the internal secretion of the parathyroids, now called parathormone. It was not until 1926 that the relation of fibrocystic osteitis, described by von Recklinghausen thirty-five years before, to parathyroid adenoma was demonstrated, although Askanazy, Erdheim and others had recognized for some years the association of adenomas of the parathyroid with the fibrocystic bone changes. Mandl, in 1926, removed a parathyroid adenoma from a patient suffering from osteitis fibrosa cystica, and observed regression in the bone changes and marked clinical improvement in the patient's general condition. Since that time our knowledge of the syndrome of parathyroid adenoma has been greatly enriched from many sources, especially through the work of Fuller Albright and his associates in Boston. We were able in this clinic in 1939 to fill a gap in the natural history of the parathyroid adenoma by describing an instance of death from parathormone intoxication(1). The patient, a woman of 49, came in complaining of tiredness and pain in the right chest. The correct diagnosis was not suspected until x-ray plates showed a stippling of calcium in the parenchyma of the kidneys (fig. 1 and 2) with generalized decalcification of the bones. The serum calcium ranged from 20 to 22 mg. per 100 cc., and the phosphorus on two determinations was 4.7 and 1. Hanes, F. M.: Hyperparathyroidism Due to Parathyroid Adenoma, with Death from Parathormone Intoxication. Am. J. M. Sc. 197:85-90 (Jan.) 1939. (For full bibliography see Shelling, D. H.: The Parathyroids in Health and Disease, St. Louis, C. V. Mosby Co., 1935.) Fig. 2. Parenchymatous calcification of the kidney in parathyroid adenoma. The calices are seen to enclose the tips of the calcified pyramids. 4.8 mg. per 100 cc. of serum. The temperature ranged from 38 C. (100.4 F.) to 38.5 C. (101.3 F.)—a fever now recognized as due to parathormone intoxication. The patient died suddenly, and postmortem examination revealed widespread necrosis and calcification of the kidneys, lungs and stomach, and especially of the arteries and muscle fibers of the heart. The clinical and pathological observations in this patient paralleled closely those reported in rats and dogs suffering from parathormone poisoning. The clinical manifestations of parathyroid adenoma areseldom striking or dramatic and, unless the clinician is properly sensitized to the syndrome, an error in diagnosis is easily possible. When bone cysts and the characteristic parenchymatous calcification of the pyramids of the kidney are present, one naturally investigates the calcium and phosphorus content of the serum; but the usual complaints of tiredness and bone-pains, with or without polydipsia and polyuria, may not put the clinician sufficiently on his guard. As is so often the case, the correct diagnosis is the reward of suspicion; once the syndrome is suspected, diagnosis is, as a rule, not too difficult. Adenomas of the parathyroid are rarely palpable, and the patient's symptoms may be increased by massaging more parathormone into the circulation, after the analogy of paroxysmal hypertension in chromaffin tumors of the adrenal. The highly characteristic, though probably not pathognomonic, deposits of calcium in the pyramids of the kidney (fig. 1 and 2) are due to necrosis of tissue with subsequent calcification. They have a high diagnostic
Object Description
Rating | |
Fixed Title * | NCHH-17: North Carolina Medical Journal [1940-2001] |
Document Title | North Carolina Medical Journal [1940-2001] |
Subject Topical Other | Public Health -- Periodicals.; Physicians -- North Carolina -- Directory.; Societies, Medical -- North Carolina -- Periodicals. |
Description | Includes Transactions of the Society, -1960; 1961- , Transactions issued separately, bound in.; Includes Transactions of the auxiliary to the Medical Society of the State of North Carolina and Proceedings of the North Carolina Public Health Association. Official organ of the Medical Society of the State of North Carolina, 1940-May 1972; of the North Carolina Medical Society, June 1972-. Vols. for 1940-May 1972 published by the Medical Society of the State of North Carolina; June 1972- by the North Carolina Medical Society. |
Contributor | Medical Society of the State of North Carolina. Transactions.; Medical Society of the State of North Carolina.; North Carolina Medical Society.; North Carolina Medical Society. Transactions.; North Carolina Public Health Association. Proceedings. |
Publisher | [Winston-Salem] : North Carolina Medical Society [etc.], 1940- |
Repository | University of North Carolina at Chapel Hill. Health Sciences Library. |
Host | University of North Carolina at Chapel Hill |
Date | 1945 |
Identifier | NCHH-17-006 |
Form General | Periodicals |
Language | English |
Rights | This item is part of the North Carolina History of Health Digital Collection. Some materials in the Collection are protected by U.S. copyright law. This item is presented by the Health Sciences Library of the University of North Carolina at Chapel Hill for research and educational purposes. It may not be republished or distributed without permission of the Health Sciences Library. |
Digital Collection | North Carolina History of Health Digital Collection |
Sponsor | The North Carolina History of Health Digital Collection is an open access publishing initiative of the Health Sciences Library of the University of North Carolina at Chapel Hill. Financial support for the initiative was provided in part by a multi-year NC ECHO (Exploring Cultural Heritage Online) digitization grant, awarded by the State Library of North Carolina, and funded through the Library Services and Technology Act (LSTA). |
Volume Number | 6 |
Health Discipline | Medicine |
Digital Format | JPEG 2000 |
Print / Download PDF Version | http://archives.hsl.unc.edu/nchh/nchh-17/nchh-17-006.pdf |
Document Sort | all; nchh-17 |
Volume Link | http://dc.lib.unc.edu/cdm/search/collection/nchh/field/identi/searchterm/NCHH-17-006 |
Title Link | http://dc.lib.unc.edu/cdm/search/collection/nchh/field/documa/searchterm/NCHH-17 |
Catalog Record link | http://search.lib.unc.edu/search?R=UNCb1306322 |
Description
Fixed Title * | Page 509 (image) |
Document Title | North Carolina Medical Journal [1940-2001] |
Subject Topical Other | Public Health -- Periodicals.; Physicians -- North Carolina -- Directory.; Societies, Medical -- North Carolina -- Periodicals. |
Description | Includes Transactions of the Society, -1960; 1961- , Transactions issued separately, bound in.; Includes Transactions of the auxiliary to the Medical Society of the State of North Carolina and Proceedings of the North Carolina Public Health Association. Official organ of the Medical Society of the State of North Carolina, 1940-May 1972; of the North Carolina Medical Society, June 1972-. Vols. for 1940-May 1972 published by the Medical Society of the State of North Carolina; June 1972- by the North Carolina Medical Society. |
Contributor | Medical Society of the State of North Carolina. Transactions.; Medical Society of the State of North Carolina.; North Carolina Medical Society.; North Carolina Medical Society. Transactions.; North Carolina Public Health Association. Proceedings. |
Publisher | [Winston-Salem] : North Carolina Medical Society [etc.], 1940- |
Repository | University of North Carolina at Chapel Hill. Health Sciences Library. |
Host | University of North Carolina at Chapel Hill |
Date | 1945 |
Identifier | NCHH-17-006-0523 |
Form General | Periodicals |
Page Type | all; all images; x-ray; article |
Language | English |
Rights | This item is part of the North Carolina History of Health Digital Collection. Some materials in the Collection are protected by U.S. copyright law. This item is presented by the Health Sciences Library of the University of North Carolina at Chapel Hill for research and educational purposes. It may not be republished or distributed without permission of the Health Sciences Library. |
Filename | northcarolinamed61945medi_0523.jp2 |
Digital Collection | North Carolina History of Health Digital Collection |
Sponsor | The North Carolina History of Health Digital Collection is an open access publishing initiative of the Health Sciences Library of the University of North Carolina at Chapel Hill. Financial support for the initiative was provided in part by a multi-year NC ECHO (Exploring Cultural Heritage Online) digitization grant, awarded by the State Library of North Carolina, and funded through the Library Services and Technology Act (LSTA). |
Volume Number | 6 |
Issue Number | 12 |
Page Number | 509 |
Health Discipline | Medicine |
Full Text | December, 1945 PARATHYROID ADENOMA—HANES 509 Fig. 1. Showing the characteristic delicate mottling due to calcification in the pyramids of the kidney (nephrocalcinosis). cium and phosphorus metabolism. This discovery threw a new light upon the metabolic functions of the parathyroids, and in 1924 Collip and others prepared an extract of the internal secretion of the parathyroids, now called parathormone. It was not until 1926 that the relation of fibrocystic osteitis, described by von Recklinghausen thirty-five years before, to parathyroid adenoma was demonstrated, although Askanazy, Erdheim and others had recognized for some years the association of adenomas of the parathyroid with the fibrocystic bone changes. Mandl, in 1926, removed a parathyroid adenoma from a patient suffering from osteitis fibrosa cystica, and observed regression in the bone changes and marked clinical improvement in the patient's general condition. Since that time our knowledge of the syndrome of parathyroid adenoma has been greatly enriched from many sources, especially through the work of Fuller Albright and his associates in Boston. We were able in this clinic in 1939 to fill a gap in the natural history of the parathyroid adenoma by describing an instance of death from parathormone intoxication(1). The patient, a woman of 49, came in complaining of tiredness and pain in the right chest. The correct diagnosis was not suspected until x-ray plates showed a stippling of calcium in the parenchyma of the kidneys (fig. 1 and 2) with generalized decalcification of the bones. The serum calcium ranged from 20 to 22 mg. per 100 cc., and the phosphorus on two determinations was 4.7 and 1. Hanes, F. M.: Hyperparathyroidism Due to Parathyroid Adenoma, with Death from Parathormone Intoxication. Am. J. M. Sc. 197:85-90 (Jan.) 1939. (For full bibliography see Shelling, D. H.: The Parathyroids in Health and Disease, St. Louis, C. V. Mosby Co., 1935.) Fig. 2. Parenchymatous calcification of the kidney in parathyroid adenoma. The calices are seen to enclose the tips of the calcified pyramids. 4.8 mg. per 100 cc. of serum. The temperature ranged from 38 C. (100.4 F.) to 38.5 C. (101.3 F.)—a fever now recognized as due to parathormone intoxication. The patient died suddenly, and postmortem examination revealed widespread necrosis and calcification of the kidneys, lungs and stomach, and especially of the arteries and muscle fibers of the heart. The clinical and pathological observations in this patient paralleled closely those reported in rats and dogs suffering from parathormone poisoning. The clinical manifestations of parathyroid adenoma areseldom striking or dramatic and, unless the clinician is properly sensitized to the syndrome, an error in diagnosis is easily possible. When bone cysts and the characteristic parenchymatous calcification of the pyramids of the kidney are present, one naturally investigates the calcium and phosphorus content of the serum; but the usual complaints of tiredness and bone-pains, with or without polydipsia and polyuria, may not put the clinician sufficiently on his guard. As is so often the case, the correct diagnosis is the reward of suspicion; once the syndrome is suspected, diagnosis is, as a rule, not too difficult. Adenomas of the parathyroid are rarely palpable, and the patient's symptoms may be increased by massaging more parathormone into the circulation, after the analogy of paroxysmal hypertension in chromaffin tumors of the adrenal. The highly characteristic, though probably not pathognomonic, deposits of calcium in the pyramids of the kidney (fig. 1 and 2) are due to necrosis of tissue with subsequent calcification. They have a high diagnostic |
Digital Format | JPEG 2000 |
Print / Download PDF Version | http://archives.hsl.unc.edu/nchh/nchh-17/nchh-17-006.pdf |
Document Sort | all; nchh-17 |
Article Title | Parathyroid Adenoma: A Clinical And Biochemical Discussion |
Article Author | Frederick M. Hanes |
Volume Link | http://dc.lib.unc.edu/cdm/search/collection/nchh/field/identi/searchterm/NCHH-17-006 |
Title Link | http://dc.lib.unc.edu/cdm/search/collection/nchh/field/documa/searchterm/NCHH-17 |
Catalog Record link | http://search.lib.unc.edu/search?R=UNCb1306322 |
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