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Neuromuscular involvement in mild, asymptomatic primary hyperparathyroidism.
S A Turken1, M Cafferty, S J Silverberg
1Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, New York 10032.
The American Journal of Medicine
|November 1, 1989
Summary
Classic neuromuscular symptoms are rare in modern primary hyperparathyroidism patients. Neurologic findings are less common, with sensory changes and paresthesias being more prevalent in this updated clinical profile.
Area of Science:
- Endocrinology
- Neurology
- Internal Medicine
Background:
- Primary hyperparathyroidism historically presented with distinct neuromuscular abnormalities.
- Modern patient populations are often asymptomatic, necessitating a re-evaluation of clinical manifestations.
Purpose of the Study:
- To investigate the prevalence of neuromuscular abnormalities in contemporary patients with primary hyperparathyroidism.
- To compare current findings with historical descriptions of the disease's neurologic impact.
Main Methods:
- Studied 42 patients with primary hyperparathyroidism (serum calcium 11.1 +/- 0.1 mg/dL).
- Assessed neuromuscular status through clinical examination, sensory testing, and reflex evaluation.
- Utilized laboratory tests including parathyroid hormone levels and creatine phosphokinase.
- Performed electromyography and nerve conduction studies in a subset of patients.
Main Results:
- Generalized weakness and fatigability were common complaints but not objectively observed on examination.
- No patients exhibited classic signs like muscle weakness, atrophy, or hyperreflexia.
- Paresthesias and muscle cramps were reported by 52% of patients.
- Neurologic findings included sensory loss (pain, vibration) and diminished reflexes in 29% of patients.
- Electromyography and nerve conduction studies revealed isolated nerve abnormalities or nonspecific sensory neuropathy in some patients, with no evidence of myopathy or denervation.
Conclusions:
- The classic neuromuscular syndrome of primary hyperparathyroidism is infrequently observed in current patient cohorts.
- The neurologic presentation of primary hyperparathyroidism has evolved, reflecting changes in the disease's overall clinical profile.
- Sensory disturbances and subjective complaints like paresthesias are more characteristic of contemporary cases.