CORONARY-ARTERY DISEASE AS 1ST MANIFESTAT ION OF PRIMARY HYPERPARATHYROIDISM

Due to unstable angina pectoris coronary arteriography was performed i n a 57 year-old female, showing diffuse 3-vessel disease; aortocoronar y bypass surgery was recommended. During routine pre-operative examina tion hypercalcemia, as well as an elevated value of parathormone were observed. Ultrasonography of the parathyroid glands showed two enlarge d cranial glands. In a simultaneous surgical procedure 4 bypass grafts were performed and 4 hyperplastic parathyroid glands were removed, on e of which was re-operated as an auto-transplantation in the left musc ulus adductor magnus. Histological examination showed water clear cell hyperplasia of the parathyroid glands. Though the patient had suffere d from stomach and duodenal ulcers and nephrolithiasis over several ye ars, primary hyperparathyroidism was diagnosed only after angiographic ally proven coronary artery disease.