1. The significance of early detection, diagnosis and treatment of asymptomatic primary hyperparathyroidism in primary health care Dr Aleksandra Ješić Dr Aleksandra Kosojević Dr Ljiljana Jandrić Health Center“Novi Beograd“ Belgrade, Serbia

2. Primary hyperparathyroidism occurs as a result of increased and uncontrolled secretion of parathyroid hormone due to hyper function of one or more paratiorid glands. Primary hyperparathyroidism is the third most common endocrine disease with the highest incidence among women in the postmenopausal period.
Women are affected two to three times more often than men, especially menopausal women with a prevalence of 21 / 1000 women aged between 55 and 75 years. Side effects of php on bone tissue are of particular interest in a group of women in post menopause.

3. Case Report
The patient, born in 1953, comes to family doctor complaining of pain in her leg muscles, constant fatigue, and sleepiness, pain in the spine ls, as well as occasional bloating and nausea.
Records from the health records of associated diseases show that the patient has treated and controlled primary hypertension and acute gastritis.

4. Basic laboratory analysis:
Alkaline phosphates 51 U/L ( U /L)
Potassium 3.9 mml/l ( )
Other in reference limits
ECG: sinus rhythm, Fr 57/min, longer qt interval, shallow t waves
Ta 145/95 mm hg
Echo abdomen with no signs of renal calculi and gallbladder
Rtg l-s spine: signs of diffuse osteoporosis without cyst formation
Sent to physiatrist

5. Physiatrist
Finding dEXA; t score l-s spine -2.6(Osteoporosis)
Ca in urine /24 h 10.22mml/24 h ( )
P/S Calcium total 2.29 mml/l ( )
P/S inorganic phosphate 0.83 mmol/ l ( )
Phosphate in urine /24 h mmol/24 h (13-42)
PTH 118 pg/l (16-87)
Vitamin d 25 OH (75-250)
Sent to endocrinologist

6. Endocrinologist
Echo thyroid: Struma mycronodosa gl. Thyroidae.Eythyreosis
Therapy: Bisphosphonates + vitamin d3 + caco3
Parathyroid gland scintigraphy: no signs of hyperplasia, adenoma or cancer

7. After two years of regular monitoring and control at 6 months the patient feels better without pain in ls spine and muscles.
Control Dexa ls spine: -1.9 t score (Osteopenia)
PTH: 70.9(12-72)

8. Primary hyperparathyroidism is a rare disease that should always be followed in a family doctor's office for postmenopausal women or dominant hypercalcaemia or hypercalciuria.
Take detailed history records, do clinical examination of the patient, also do on time diagnostic evaluation which will lead to the final diagnosis.

9. Thank you for your attention aleksandra.jesic@yahoo.com