Pseudohypoparathyroidism with Secondary Hyperparathyroidism and Osteitis Fibrosa*

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Abstract
Two patients with pseudohypoparathyroidism and unusual skeletal lesions are reported. One showed slipped femoral capital epiphyses, and both showed mild demineralization of the bones and subperiosteal resorption considered to be characteristic of hyperparathyroidism. The serum alkaline phosphatase level was elevated. Treatment with a low phosphate diet, alumina gel, probenecid, and vitamin D restored the low serum calcium level and the high phosphorus level to normal and resulted in rapid bone repair with return of the alkaline phosphatase activity to normal. This is the first demonstration of the skeletal changes of secondary hyperparathyroidism in pseudohypoparathyroidism, and is in keeping with the previously reported findings by Albright et al. of hyperplastic parathyroid glands in 2 untreated cases of this syndrome. The short metacarpals and metatarsals typical of the syndrome remained virtually unchanged. The soft-tissue calcifications progressed slightly during treatment. They are probably not related to the metabolic disturbances but rather constitute another developmental abnormality of this syndrome.