Abstract
We report a case of primary hyperparathyroidism, in which changes in bone mineral density after adenomectomy were examined by dual energy X-ray absorptiometry. The subject is male and currently 22 years old. He suffered fractures of the radial and ulnar diaphyses during a basketball game in physical education class at the age of 18 in July 1991. In September 1991, he suffered a fracture of the surgical neck of the left humerus in a near collision with an automobile while he was riding a motorcycle. The subject first visited our clinic because of general malaise and pain in his fingers and forearms around July 1992. He was admitted to our hospital because hypercalcemia and elevation of serum parathyroid hormone (PTH) level were found. In addition to hypercalcemia, hypophosp-hatemia, elevation of alkaline phosphatase concentration, high serum levels of PTH-intact, elevation of the urinary of c-AMP excretion, and depression of the renal tubular reabsorption rate of phos-phate were found. A parathyroid adenoma about 10mm in diameter was recognized on the posterior surface of the right lobe of the thyroid gland. In the corresponding region, a hot area was observed by201Tl-99mTcO4-subtraction scintigraphy. These findings led us to the diagnosis of right parathyroid adenoma, and adenomectomy was perf omed. The tumor was a benign solitary adenoma. After the excision of the tumor, the serum concentrations of calcium and PTH normalized rapidly and the symptoms such as general malaise and pain in the upper extremities disappeared. During the follow-up period of about two and a half years, the serum concentrations of calcium and PTH have remained within the normal range. The bone mineral density in the lumbar vertebrae has increased, but has not yet reached a normal value. This indicates that a long time is required for the normalization of bone mineral density after adenomectomy
