Background. Primary hyperparathyroidism is an endocrine disease resulting from a primary pathology of the parathyroid gland, characterized by increased secretion of parathyroid hormone and increased blood calcium levels. Among the endocrine diseases, primary hyperparathyroidism is the third most common after diabetes mellitus and thyroid disease. Without timely diagnosis, primary hyperparathyroidism causes systemic damage to internal organs: renal impairment, nephrolithiasis, esophageal affection, cardiovascular and nervous system and affects bones. The aim of the work was to present a clinical case of a patient with primary hyperparathyroidism and to analyze the stages of its diagnosis and treatment. Material and methods. We reviewed the relevant literature and analyzed the patient’s medical records. Results and Discussion. The patient had a complicated course of primary hyperparathyroidism of bone and visceral form. Despite of the slow progression and availability of screening methods, hyperparathyroidism was detected at the stage of complications. The efficacy of the therapy has been assessed. The underlying reasons that made it difficult to diagnose PHPT at an early stage, before the development of serious complications of internal organs were investigated. Conclusions: It can be assumed that our clinical case will increase the awareness of physicians, especially therapists, about the primary manifestations of this pathology and the challenges of its detecting and avoiding diagnostic errors.

Aim. To estimate the role of endogenous metabolic factors in formation of vascular endothelium reactivity in patients with different genesis cardiovascular regulation disorders.Materials and methods. The research included 30 patients with ischemic heart disease (IHD) with stable form of exertional angina (EA) of II–III severity class, 30 patients with I–II stage and 1st–2nd degree essential hypertension (EH), and 15 clinically healthy volunteers. We researched the signs of functional state of vascular endothelium before and after occlusion test. The parameters investigated included: adhesion of thrombocytes, spontaneous aggregation, prostacyclin activity of blood plasma, levels of antithrombine-III, of von Willebrand factor, contents of malonic aldehyde, of nitrites, of endothelin-1, of membrane-connected haemoglobin, of methaemoglobin in erythrocytes, activity of angiotensineconverting enzyme, level of sorption on the membrane of erythrocytes of nucleotides. Research of hemorheology was performed by viscosimetry method.Results. In healthy volunteers high probability of endothelium sensitivity to transverse strain decrease (in 82%) was determined and 25% increase of activity of peroxide oxidation of lipids. In patients with exertional angina influence of dynamic changes of blood flow on endothelium occurred by 2% decrease of viscosity and more than 120% increase of production von Willebrand factor (in 87%). It was concluded that as higher the production of prostacyclin in response to mechanic stimuli (more than 50%) is, the higher is probability of blood flow dynamic changes influence on endothelium. In patients with essential hypertension 30% increase of level of antithrombine-III in 100% of cases caused increase of sensibility of vascular endothelium to transverse strain.Conclusion. The most significant factors linked with sensibility of endothelium of vascular wall to dynamic blood flow changes in examined groups of patients were determined. In patients with exertional angina vascular reaction was mostly linked with rheological qualities and adhesive-aggregation characteristics of blood. In patients with essential hypertension the sensitivity of vascular endothelium was implied to be concordant with anticoagulant activity of blood plasma.

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