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  • • End-stage skeletal manifestation of severe hyperparathyroidism

    • Rarely seen now in industrialized societies

    • Consists of bone cysts, osteoporosis, and brown tumors (result of excessive osteoclastic bone resorption)

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Epidemiology

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  • • Historically, 15% of hyperparathyroid patients presented with bone disease

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Symptoms and Signs

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  • • Pain

    • Pathologic fractures

    • Paraplegia (secondary to vertebral collapse)

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Laboratory Findings

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  • • Elevated serum calcium

    • Elevated intact parathyroid hormone level

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Imaging Findings

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  • • Bone radiographs demonstrate osteoporosis, fractures, cysts

    • Subperiosteal resorption of the radial aspect of the index and long fingers

    • Increased uptake on bone scan

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Rule Out

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  • • Parathyroid carcinoma

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  • • Bone scan

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  • • Only effective treatment is the localization and excision of all abnormal parathyroid tissue

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Surgery

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Indications

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  • • All patients with osteitis fibrosa cystica should have parathyroidectomy

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Medications

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  • • Calcium and vitamin D supplementation postoperatively to aid in bone remineralization

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Treatment Monitoring

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  • • Monitor serum calcium and intact parathyroid hormone level

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Prognosis

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  • • Reversal of bone loss is common after parathyroidectomy, but recovery of bone mass to normal is rare

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References

Agarwal G et al. Recovery pattern of patients with osteitis fibrosa cystica in primary hyperparathyroidism after successful parathyroidectomy. Surgery. 2002;132:1075.  [PubMed: 12490858]
Raeburn CD et al. End-stage skeletal manifestations of severe hyperparathyroidism. Surgery. 2002;132:896.  [PubMed: 12464877]

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