Case Reports

Hyperparathyroidism with Dental Involvement

A Discussion of Examination, Diagnosis, and Operative Findings.

By Dr. V.W. Dedon, St. Paul, Minn.

 

Complaint

Miss A.J. came to my office January 6th, 1933, for a dental examination, complaining of teeth getting loose, fatigue, pain in limbs, nervousness, and irritability.

History

White female, age thirty years. For more than two years the patient said she had been tired on rising, especially in the legs. Later she had pain in the arms and was nervous and irritable, and stated that she had some kidney disturbance.

Examination

Teeth X-rayed. Sinuses checked and found clear. Teeth seemed loose, with pus flowing from around  a number of them. X-rays revealed that the alveolar crest was gone around lower left bicuspids and lower right cuspid, bicuspids and molars. The upper right lateral, cuspid and bicuspid had cystic areas at apex, but were vital. Bone very thin in decalcified areas, especially below lower left biscuspid and cuspid.

Working Diagnosis

Looseness of teeth due to pyorrhea condition and decalcified bone due to some systemic cause, which proved to be glandular. Teeth acting as foci causing neuritis.

Operative Findings

On extracting the teeth, the bone was found to be very much decalcified and on upper right side a flap was laid back from right central to molars. Cystic areas were found which proved to be blood cysts—tissue very vascular.

On the upper left the bone seemed like rubber. All the upper teeth and some lower teeth were removed. After removal of the teeth the patient was referred to her physician, and his attention called to decalcified condition of the bone.

 

 

Systemic Findings

Patient reported for medical attention May 1st, 1933, when she fractured her left wrist by a slight blow against her desk. X-rays revealed not only a fracture of the ulna and radius but a moth eaten appearance of the bones. The case was then sent to the Ancker Hospital for observation.

At Ancker Hospital, Dr. Joseph Borg of St. Paul made the diagnosis of hyperparathyroidism, by X-rays of the skeletal system and blood analysis. Blood calcium was high and blood phosphorus low. There was a marked increase in calcium excretion in the urine.

The patient was operated by Dr. A.R. Colvin, July 21, 1933. He performed a partial thyroidectomy and removed a cystic tumor which was found in the upper mediastinum. The cyst was found to contain parathyroid tissue. The patient made a remarkable recovery, gained in weight and strength, and is in perfect health today.

Remarks

In the accompanying illustrations, note the restoration of calcium in skull, radius and ulna, six weeks after operation. Also the increased density of the mandible taken shortly after the operation.

Many of these cases have renal calculi and often have tumors in the mouth which sometimes have been diagnosed as sarcoma and which should have been correctly diagnosed as hyperparathyroidism.

 

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