Manifestações neurologicas do hiperparatireoidismo: estudo de 120 casos

Rizzo, Geraldo Nunes Vieira; Olanow, C. Warren

doi:10.1590/S0004-282X1982000300001

Resumos

É feito um estudo retrospectivo de 120 pacientes internados para investigação de hiperparatireoidismo. Tendo em vista as manifestações neurológicas do hiperparatireoidismo primário realizamos também um confronto com os achados de outros autores.

The neurologic findings in 120 patients with possible diagnosis of hyperparathyroidism are reported and the world literature on this matter is reviewed. The neurologic signs and symptoms were divided in 3 categories: central, peripherical and miscelaneous. Headache, cramps weakness and depression where the most frequent complaints but with a so wide list of symptoms we expect mainly to salient the importance of calcium and phosphorus blood levels on neurologic patientes as well as the value of neurologic evaluation on hyperparathyroid patients.

Manifestações neurologicas do hiperparatireoidismo: estudo de 120 casos

Neurologic manifestations of hyperparathyroidism

Geraldo Nunes Vieira Rizzo^I; C. Warren Olanow^II

^INeurologista e Eletrencefalografista, ex-Rotary fellow na Divisão de Neurologia Duke University

^IIProfessor of Neurology na Duke University

RESUMO

É feito um estudo retrospectivo de 120 pacientes internados para investigação de hiperparatireoidismo. Tendo em vista as manifestações neurológicas do hiperparatireoidismo primário realizamos também um confronto com os achados de outros autores.

SUMMARY

The neurologic findings in 120 patients with possible diagnosis of hyperparathyroidism are reported and the world literature on this matter is reviewed. The neurologic signs and symptoms were divided in 3 categories: central, peripherical and miscelaneous. Headache, cramps weakness and depression where the most frequent complaints but with a so wide list of symptoms we expect mainly to salient the importance of calcium and phosphorus blood levels on neurologic patientes as well as the value of neurologic evaluation on hyperparathyroid patients.

Texto completo disponível apenas em PDF.

Full text available only in PDF format.

Trabalho realizado na Duke University Medical Center, Duke University, Durham. North Carolina, U.S.A.

Dr. Geraldo Nunes Vieira Rizzo - Rua Comendador Caminha 286 - apto. 502 - 90000 Porto Alegre, RS - Brasil.

1. AITA, J. A. - Neurologic manifestations of endocrine disorders. Nebraska Med. J. 46:443, 1961.
2. ALBRIGHT, F. - Acute atrophy of bone (osteoporosis) simulating hyperparathyroidism. J. Clin. Endocr. 1:711, 1941.
3. ALLEN, E. M.: SINGER. F. R. & MALAMED, D. - Eletroencephalografic abnormalities in hypercalcemia. Neurology (Minneapolis) 20:15, 1970.
4. ANSPACH, W. E. & CLIFTON, W. M. - Hyperparathyroidism in children: reported of two cases. Am. J. Dis. Child. 58:540, 1939.
5. AURBACH, G. D.; MALLETE, L. E.; PATTEN, B. M.; HEATH, D. A.; DOPPMAN, J. L. & BILEZIKIAN, J. P. - Hyperparathyroidism: recent studies. Ann. Intern. Med. 79 (4):556, 1973.
6. BARNES. B. A. & COPE, O. - Carcinoma of the parathyroid glands: report of 10 cases with endocrine function. J. Amer. Med. Ass. 178:556, 1961.
7. BARR, D. P. & BULGER, H. A. - The clinical sindrome of hiperparathyroidism. Am. J. M. Sc., 179:449, 1930.
8. BARTTER, F. C. - The parathyroid gland and its relationship to diseases of the nervous system. Res. Pub. Ass. Res. Nerv. Ment. Dis. 32, 1, 1952.
9. BEARE, J. M. & MILLER, J. H. D. - Epileptiform fits during calciferol therapy. Lancet 1:884, 1951.
10. BISCHOFF, A. & ESSLEN, E. - Myopathy with primary hiperparathyroidism. Neurology, 15:64, 1965.
11. BOGDONOFF, M. D.; WOODS, A. H.; WHITE, J. E. & ENGEL, F. L. - Hyperparathyroidism. Amer. J. Med. 21:588, 1956.
12. BOYD, J. D.: M1LGRAM, J. E. & STEARNS, G. - Clinical hiperparathyroidism. J. A. M. A. 93:684, 1929.
13. CHOLOD, E. J.; HAUST, M. D.: HUDSON, A. J. - Myopathy in primary familial hyperparathyroidism. Amer. J. Med. 48:700, 1970.
14. COLLIP. J. B. - The parathyroid glands. Medicine 5:1, 1926.
15. COPE, O.; NARDI, G. L. & CASTKEMAN, B. - Carcinoma of parathyroid glands. Ann. Surg. 138:661. 1953.
16. DERBYSHIRE, R. C. & ANGLE. R. M. - Acute hyperparathyroidism: case report. Amer. Surg. 26:166, 1960.
17. DODD, K.; GRAUBARTH, H. & RAPOPORT, S. - Hypercalcemia, nephropathy and encephalopathy following immobilization. Pediatrics 6:124, 1950.
18. EDWARDS, G. A. & DAUM, S. M. - Increased spinal fluid protein in hyperparathyroidism and other hypercalcemic states. Arch. Intern. Med. 104:29, 1959.
19. EHRLICH, G. A.; McDONALD, J. & ZITAN, A. - Carcinoma of the parathyroid with hyperparathyroidism and metastases. J. Amer. Med. Ass. 176:453, 1961.
20. EIDEKEN, J. & NAGEL, W. - Hyperparathyroidism with pseduo-erosion of sella turcica. AMA Arch. Intern.. Med. 104:430, 1959.
21. EITINGER, L. - Hyperparatyreoidisme og Psychiske Forandringer. Nord. Med., 14:1581, 1942.
22. ETHERIDGE, J. E. & GRADOW, J. D. - Hypercalcemia without EEG abnormalities. Dis. Nerv. Syst. 32. 479, 1971.
23. FABRYKANT, M. - Neuropsychatric manifestations of somatic disease: review of nutritional, metabolic and endrocrine aspects. Metabolism 9:412, 1960.
24. F1TZ, T. E. & HALLMAN, B. L. - Mental changes associated with hyperparathyroidism: report of two cases. Arch. Intern. Med. 89:547, 1952.
25. FRAME, B.: HEINZE, E. G. Jr.; BLOCK, M. A. - Myopathy in primary hyperparathyroidism: observations in 3patientes. Ann. Intern. Med. 68:1022, 1968.
26. GATEWOOD, J. W.; ORGAN, C. H. & MEAD, B. T. - Mental changes associated with hyperparathyroidism. Am. J. Psychiatry 132 (2):129, 1975.
27. GUTMAN, A. B.; SWENSON, P. C. & PARSONS, W. B. - The differential diagnosis of hyperparathyroidism. J. Amer. Med. Ass. 103:87, 1934.
28. HANES, F. M. - Hyperparathyroidism due to parathyroid adenoma with death from parathormone intoxication. Am. J. M. Sc. 197:85, 1939.
29. HANNON, R. R.; SHORR, E.; McCLELLAN. W. S. & DU BOIS, E. F. - Case of osteitis fibrosa cystica (osteomalaria?) with evidence of hyperactivity of the parathyroid bodies: metabolic study. J. Clin. Invest. 8:215, 1930.
30. HARMON, M. - Parathyroid adenoma in a child: report of a case presenting as central nervous system disease and complicated by magnesium deficiency. AMA. J. Dis. Child. 91:313, 1956.
31. HARVEY, A. M. & MACINTOSH, F. C. - Calcium and synaptic transmission in a sympathetic ganglion. J. Physiol. 97:408, 1940.
32. HENSON, R. A. - The neurologic aspects of hypercalcemia: with special reference to primary hyperparathyroidism. J. Roy. Coll. Phycns (London) 1:41, 1966.
33. HEWSON, J. S. - Parathyroid crisis: cause of sudden death. AMA. Arch. Intern. Med. 102:199, 1958.
34. HILLIARD, J. M. - Primary hyperparathyroidism. Cand. Med. Ass. J. 87:1107, 1962.
35. HIRSCHBERG, K. - Zur Kenntnise der Osteomalacie und ostitis malacissans. Beitr. Pathol. 6:513, 1889.
36. HOCKADAY, T. D. R.; KEYNES, W. M. & McKenzie, J. K. - Catatonic stupot in elderly woman with hyperparathyroidism. British Med. J. 1:85, 1966.
37. KARPATY, G. & FRAME, B. - Neuropsychiatry disorders in primary hyperparathyroidism. Arch. Neurol. (Chicago) 10:387, 1964.
38. KELLY, J. S.; KRNJEVIC, K. .& SOMJEN, G. - Divalent cations and elétrica] properties of cortical cells. J. Neurobiol. 2:197, 1969.
39. KIND, H. - Psychise störungen bein hyperparathyroidismus. Arch.-Psychiat. Nervenk. 200:1, 1959.
40. KNUTH, W. P. & KISNER, P. - Symmetrical cerebral calcification associated with parathyroid adenoma. J. A. M. A. 162:462, 1956.
41. KOUPERNICK, C. - Les parathyroides en psychiatrie. In Encyclopedie medico -chirurgicale psychiatrie 37640 E10, 4 (12-1958).
42. KUGELBERG, E. - Neurologic mechanisms for certain phenomena in tetany. Arch. Neurol & Psychiat. (Chicago) 56-507, 1946.
43. LEE, C. M. Jr.; McELHINNEY, W. T. & GALL, E. A. - Unusual manifestation of parathyroid adenoma, AMA Arch. Surg. 71:475, 1955.
44. LEHRER, G, M. & LEVITT, M. F. - Neuropsychiatric presentation of hypercalcemia. Journal of the Mount Sinai Hospital 27:10, 1960.
45. LEMANN, J. Jr. .& DONATELLI, A. - Calcium intoxication due to primary hyperparathyroidism: medical and surgical emergency. Ann. Intern. Med. 60:447, 1964.
46. LOWENBURG, H. & GINSBURG, T. M. - Acute hypercalcemia: report of a case. J. A. M. A. 99:1166, 1932.
47. MANDL, F. - Klinisches und Experimentalles zur Frage der lokalisierte und generalisierteb ostitis fibrosa. Arch. klin. chir. 143:1, 1926.
48. MICHER, W. C. Jr.; THIBAUDEAU, Y. & FRAME, B. - Primary hyperpara-thyroidims: diagnostic challenge. Arch. Intern. Med. 107:361, 1961.
49. MORSE, E. K. - Peptic ulcer, manifestations of hyperparathyroidism. J. Maine Med. Ass. 51:1, 1960.
50. MOURE, J. M. B. - The eletroencephalogram in hypercalcemia. Arch. Neurol. (Chicago) 17:34, 1957.
51. MURPHY, T. T.; REMINE, W. H. & BURBANK, M. K. - Hyperparathyroidism: reported of a case in wich parathyroid adenoma presented primarily with profound muscular weakness. Proc. Mayo Clin. 35:629, 1960.
52. NIELSEN, H. - Familial ocurrence of gastro-intestinal symptoms and mental disturbances in hyperparathyroidism. Acta. Med. Scand. 151:359, 1955.
53. NORRIS, E. H. - Parathyroid adenoma: study of 322 cases. Intern. Abstr. Surg, 84:1, 1947.
54. OLIVER, W. A. - Acute hyperparathyroidism. Lancet 2:240, 1939.
55. PATTEN, B. M.; BILEZIKIAN, J. P.; MALLETE, L. E.; PRINCE, A.; ENGEL, W. K. & AURBACH, G. D. - Neuromuscular disease in primary hiperparathyroidism. Ann. Intern. Med. 80:182. 1974.
56. PRINEAS, J. W.; MASON, A. S. & HENSON, R. A. - Myopathy in metabolic bone disease. British Med. J. 1:1034, 1965.
57. PYRAH, L. N.; HODGK1NSON, A. & ANDERSON, C. K. - Primary hyperparathyroidism: critical review. British J. Surg. 53:246, 1966.
58. REINFRANK, R. F. - Primary hyperparathyroidism with depression. Arch. Intern. Med. 108:606, 1961.
59. RICHET, C; SOURDEL, M. & PERGOLA, A. - Syndromes parathyroidomuscularies miopathies slereuses lies a des troubles parathyroidens. J. Med. Franc. 26:377, 1932.
60. SCHLESINGER, B. E.; BUTLER, N. R. .& BLACK, J. A. - Severe type of infantile hypercalcemia. British Med. J. 1:127, 1956.
61. SCHNEIDER, R. W. & ROBNETT, A. H. - Diagnosis of obscure hyperparathyroidism. Cleveland Clin. Quart. 18:66, 1951.
62. SCHRUMPF, A. & HARBITZ, H. F. - Case of hyperparathyroidism with nephro-calcinosis and azotemia: operative treatment with removal of 2 parathyroid tumors. Acta. Chir. Scand 80:199, 1937.
63. SIMPSON, J. A. - Aphonia and deafness in hyperparathyroidism. British Med. J. 1:494, 1954.
64. SNAPER, I. - Gezwel van een bijschilcklies en skeletafwijkingen. Ned. T. Geneesk. 73:4758, 1929.
65. SOLANDT, D. Y. - Measurement of accommodation in nerve. Proc. Royal Soc. (London) 119:355, 1936.
66. STREETO, J. M. - Acute hypercalcemia simulating basilar-artery insufficiency. N. Engl. J. Med. 280:427, 1969.
67. SWASH, M. & ROWAN, J. - Eletroencephalographic criteria of hypocalcemia and hypercalcemia. Arch. Neurol. (Chicago) 26:218, 1972.
68. THOMAS, W. C. Jr. - Hypercalcemic crisis due to hyperparathyroidism. Amer. J. Med. 24:229, 1958.
69. VICALE, C. T. - Diagnostic features of muscular syndrome resulting from hyperparathyroidism, osteomalacia owing to renal tubular acidosis and perhaps to related disorders of calcium metabolism. Trans. Amer. Neurol. Ass. 74:143, 1949.
70. WAIFE, S. O. - Parathyrotoxicosis: syndrome of acute hyperparathyroidism. Amer. J. Med. Sci. 218:624, 1949.
71. YARYURA, J. A.; WHITE, L.; DIAMOND, B. & MESLIS, S. - The effect of calcium on behavior and drug-induced extrapyramidalism. Cur. Ther. Research. 11:677, 1969.

Datas de Publicação

Publicação nesta coleção
16 Ago 2012
Data do Fascículo
Set 1982

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

[1] 1. AITA, J. A. - Neurologic manifestations of endocrine disorders. Nebraska Med. J. 46:443, 1961.

[2] 2. ALBRIGHT, F. - Acute atrophy of bone (osteoporosis) simulating hyperparathyroidism. J. Clin. Endocr. 1:711, 1941.

[3] 3. ALLEN, E. M.: SINGER. F. R. & MALAMED, D. - Eletroencephalografic abnormalities in hypercalcemia. Neurology (Minneapolis) 20:15, 1970.

[4] 4. ANSPACH, W. E. & CLIFTON, W. M. - Hyperparathyroidism in children: reported of two cases. Am. J. Dis. Child. 58:540, 1939.

[5] 5. AURBACH, G. D.; MALLETE, L. E.; PATTEN, B. M.; HEATH, D. A.; DOPPMAN, J. L. & BILEZIKIAN, J. P. - Hyperparathyroidism: recent studies. Ann. Intern. Med. 79 (4):556, 1973.

[6] 6. BARNES. B. A. & COPE, O. - Carcinoma of the parathyroid glands: report of 10 cases with endocrine function. J. Amer. Med. Ass. 178:556, 1961.

[7] 7. BARR, D. P. & BULGER, H. A. - The clinical sindrome of hiperparathyroidism. Am. J. M. Sc., 179:449, 1930.

[8] 8. BARTTER, F. C. - The parathyroid gland and its relationship to diseases of the nervous system. Res. Pub. Ass. Res. Nerv. Ment. Dis. 32, 1, 1952.

[9] 9. BEARE, J. M. & MILLER, J. H. D. - Epileptiform fits during calciferol therapy. Lancet 1:884, 1951.

[10] 10. BISCHOFF, A. & ESSLEN, E. - Myopathy with primary hiperparathyroidism. Neurology, 15:64, 1965.

[11] 11. BOGDONOFF, M. D.; WOODS, A. H.; WHITE, J. E. & ENGEL, F. L. - Hyperparathyroidism. Amer. J. Med. 21:588, 1956.

[12] 12. BOYD, J. D.: M1LGRAM, J. E. & STEARNS, G. - Clinical hiperparathyroidism. J. A. M. A. 93:684, 1929.

[13] 13. CHOLOD, E. J.; HAUST, M. D.: HUDSON, A. J. - Myopathy in primary familial hyperparathyroidism. Amer. J. Med. 48:700, 1970.

[14] 14. COLLIP. J. B. - The parathyroid glands. Medicine 5:1, 1926.

[15] 15. COPE, O.; NARDI, G. L. & CASTKEMAN, B. - Carcinoma of parathyroid glands. Ann. Surg. 138:661. 1953.

[16] 16. DERBYSHIRE, R. C. & ANGLE. R. M. - Acute hyperparathyroidism: case report. Amer. Surg. 26:166, 1960.

[17] 17. DODD, K.; GRAUBARTH, H. & RAPOPORT, S. - Hypercalcemia, nephropathy and encephalopathy following immobilization. Pediatrics 6:124, 1950.

[18] 18. EDWARDS, G. A. & DAUM, S. M. - Increased spinal fluid protein in hyperparathyroidism and other hypercalcemic states. Arch. Intern. Med. 104:29, 1959.

[19] 19. EHRLICH, G. A.; McDONALD, J. & ZITAN, A. - Carcinoma of the parathyroid with hyperparathyroidism and metastases. J. Amer. Med. Ass. 176:453, 1961.

[20] 20. EIDEKEN, J. & NAGEL, W. - Hyperparathyroidism with pseduo-erosion of sella turcica. AMA Arch. Intern.. Med. 104:430, 1959.

[21] 21. EITINGER, L. - Hyperparatyreoidisme og Psychiske Forandringer. Nord. Med., 14:1581, 1942.

[22] 22. ETHERIDGE, J. E. & GRADOW, J. D. - Hypercalcemia without EEG abnormalities. Dis. Nerv. Syst. 32. 479, 1971.

[23] 23. FABRYKANT, M. - Neuropsychatric manifestations of somatic disease: review of nutritional, metabolic and endrocrine aspects. Metabolism 9:412, 1960.

[24] 24. F1TZ, T. E. & HALLMAN, B. L. - Mental changes associated with hyperparathyroidism: report of two cases. Arch. Intern. Med. 89:547, 1952.

[25] 25. FRAME, B.: HEINZE, E. G. Jr.; BLOCK, M. A. - Myopathy in primary hyperparathyroidism: observations in 3patientes. Ann. Intern. Med. 68:1022, 1968.

[26] 26. GATEWOOD, J. W.; ORGAN, C. H. & MEAD, B. T. - Mental changes associated with hyperparathyroidism. Am. J. Psychiatry 132 (2):129, 1975.

[27] 27. GUTMAN, A. B.; SWENSON, P. C. & PARSONS, W. B. - The differential diagnosis of hyperparathyroidism. J. Amer. Med. Ass. 103:87, 1934.

[28] 28. HANES, F. M. - Hyperparathyroidism due to parathyroid adenoma with death from parathormone intoxication. Am. J. M. Sc. 197:85, 1939.

[29] 29. HANNON, R. R.; SHORR, E.; McCLELLAN. W. S. & DU BOIS, E. F. - Case of osteitis fibrosa cystica (osteomalaria?) with evidence of hyperactivity of the parathyroid bodies: metabolic study. J. Clin. Invest. 8:215, 1930.

[30] 30. HARMON, M. - Parathyroid adenoma in a child: report of a case presenting as central nervous system disease and complicated by magnesium deficiency. AMA. J. Dis. Child. 91:313, 1956.

[31] 31. HARVEY, A. M. & MACINTOSH, F. C. - Calcium and synaptic transmission in a sympathetic ganglion. J. Physiol. 97:408, 1940.

[32] 32. HENSON, R. A. - The neurologic aspects of hypercalcemia: with special reference to primary hyperparathyroidism. J. Roy. Coll. Phycns (London) 1:41, 1966.

[33] 33. HEWSON, J. S. - Parathyroid crisis: cause of sudden death. AMA. Arch. Intern. Med. 102:199, 1958.

[34] 34. HILLIARD, J. M. - Primary hyperparathyroidism. Cand. Med. Ass. J. 87:1107, 1962.

[35] 35. HIRSCHBERG, K. - Zur Kenntnise der Osteomalacie und ostitis malacissans. Beitr. Pathol. 6:513, 1889.

[36] 36. HOCKADAY, T. D. R.; KEYNES, W. M. & McKenzie, J. K. - Catatonic stupot in elderly woman with hyperparathyroidism. British Med. J. 1:85, 1966.

[37] 37. KARPATY, G. & FRAME, B. - Neuropsychiatry disorders in primary hyperparathyroidism. Arch. Neurol. (Chicago) 10:387, 1964.

[38] 38. KELLY, J. S.; KRNJEVIC, K. .& SOMJEN, G. - Divalent cations and elétrica] properties of cortical cells. J. Neurobiol. 2:197, 1969.

[39] 39. KIND, H. - Psychise störungen bein hyperparathyroidismus. Arch.-Psychiat. Nervenk. 200:1, 1959.

[40] 40. KNUTH, W. P. & KISNER, P. - Symmetrical cerebral calcification associated with parathyroid adenoma. J. A. M. A. 162:462, 1956.

[41] 41. KOUPERNICK, C. - Les parathyroides en psychiatrie. In Encyclopedie medico -chirurgicale psychiatrie 37640 E10, 4 (12-1958).

[42] 42. KUGELBERG, E. - Neurologic mechanisms for certain phenomena in tetany. Arch. Neurol & Psychiat. (Chicago) 56-507, 1946.

[43] 43. LEE, C. M. Jr.; McELHINNEY, W. T. & GALL, E. A. - Unusual manifestation of parathyroid adenoma, AMA Arch. Surg. 71:475, 1955.

[44] 44. LEHRER, G, M. & LEVITT, M. F. - Neuropsychiatric presentation of hypercalcemia. Journal of the Mount Sinai Hospital 27:10, 1960.

[45] 45. LEMANN, J. Jr. .& DONATELLI, A. - Calcium intoxication due to primary hyperparathyroidism: medical and surgical emergency. Ann. Intern. Med. 60:447, 1964.

[46] 46. LOWENBURG, H. & GINSBURG, T. M. - Acute hypercalcemia: report of a case. J. A. M. A. 99:1166, 1932.

[47] 47. MANDL, F. - Klinisches und Experimentalles zur Frage der lokalisierte und generalisierteb ostitis fibrosa. Arch. klin. chir. 143:1, 1926.

[48] 48. MICHER, W. C. Jr.; THIBAUDEAU, Y. & FRAME, B. - Primary hyperpara-thyroidims: diagnostic challenge. Arch. Intern. Med. 107:361, 1961.

[49] 49. MORSE, E. K. - Peptic ulcer, manifestations of hyperparathyroidism. J. Maine Med. Ass. 51:1, 1960.

[50] 50. MOURE, J. M. B. - The eletroencephalogram in hypercalcemia. Arch. Neurol. (Chicago) 17:34, 1957.

[51] 51. MURPHY, T. T.; REMINE, W. H. & BURBANK, M. K. - Hyperparathyroidism: reported of a case in wich parathyroid adenoma presented primarily with profound muscular weakness. Proc. Mayo Clin. 35:629, 1960.

[52] 52. NIELSEN, H. - Familial ocurrence of gastro-intestinal symptoms and mental disturbances in hyperparathyroidism. Acta. Med. Scand. 151:359, 1955.

[53] 53. NORRIS, E. H. - Parathyroid adenoma: study of 322 cases. Intern. Abstr. Surg, 84:1, 1947.

[54] 54. OLIVER, W. A. - Acute hyperparathyroidism. Lancet 2:240, 1939.

[55] 55. PATTEN, B. M.; BILEZIKIAN, J. P.; MALLETE, L. E.; PRINCE, A.; ENGEL, W. K. & AURBACH, G. D. - Neuromuscular disease in primary hiperparathyroidism. Ann. Intern. Med. 80:182. 1974.

[56] 56. PRINEAS, J. W.; MASON, A. S. & HENSON, R. A. - Myopathy in metabolic bone disease. British Med. J. 1:1034, 1965.

[57] 57. PYRAH, L. N.; HODGK1NSON, A. & ANDERSON, C. K. - Primary hyperparathyroidism: critical review. British J. Surg. 53:246, 1966.

[58] 58. REINFRANK, R. F. - Primary hyperparathyroidism with depression. Arch. Intern. Med. 108:606, 1961.

[59] 59. RICHET, C; SOURDEL, M. & PERGOLA, A. - Syndromes parathyroidomuscularies miopathies slereuses lies a des troubles parathyroidens. J. Med. Franc. 26:377, 1932.

[60] 60. SCHLESINGER, B. E.; BUTLER, N. R. .& BLACK, J. A. - Severe type of infantile hypercalcemia. British Med. J. 1:127, 1956.

[61] 61. SCHNEIDER, R. W. & ROBNETT, A. H. - Diagnosis of obscure hyperparathyroidism. Cleveland Clin. Quart. 18:66, 1951.

[62] 62. SCHRUMPF, A. & HARBITZ, H. F. - Case of hyperparathyroidism with nephro-calcinosis and azotemia: operative treatment with removal of 2 parathyroid tumors. Acta. Chir. Scand 80:199, 1937.

[63] 63. SIMPSON, J. A. - Aphonia and deafness in hyperparathyroidism. British Med. J. 1:494, 1954.

[64] 64. SNAPER, I. - Gezwel van een bijschilcklies en skeletafwijkingen. Ned. T. Geneesk. 73:4758, 1929.

[65] 65. SOLANDT, D. Y. - Measurement of accommodation in nerve. Proc. Royal Soc. (London) 119:355, 1936.

[66] 66. STREETO, J. M. - Acute hypercalcemia simulating basilar-artery insufficiency. N. Engl. J. Med. 280:427, 1969.

[67] 67. SWASH, M. & ROWAN, J. - Eletroencephalographic criteria of hypocalcemia and hypercalcemia. Arch. Neurol. (Chicago) 26:218, 1972.

[68] 68. THOMAS, W. C. Jr. - Hypercalcemic crisis due to hyperparathyroidism. Amer. J. Med. 24:229, 1958.

[69] 69. VICALE, C. T. - Diagnostic features of muscular syndrome resulting from hyperparathyroidism, osteomalacia owing to renal tubular acidosis and perhaps to related disorders of calcium metabolism. Trans. Amer. Neurol. Ass. 74:143, 1949.

[70] 70. WAIFE, S. O. - Parathyrotoxicosis: syndrome of acute hyperparathyroidism. Amer. J. Med. Sci. 218:624, 1949.

[71] 71. YARYURA, J. A.; WHITE, L.; DIAMOND, B. & MESLIS, S. - The effect of calcium on behavior and drug-induced extrapyramidalism. Cur. Ther. Research. 11:677, 1969.