Clinical Crossroads Section Editor: Margaret
A. Winker, MD, Deputy Editor.
Author Affiliation: Dr Strewler is Professor
and Vice-Chairman of Medicine, Beth Israel-Deaconess Medical Center, and Master,
Walter Bradford Cannon Society, Harvard Medical School, Boston, Mass.
DR BURNS: Ms
Q is a 64-year-old woman with a history of mild hypercalcemia and hyperparathyroidism.
She has managed care insurance.
Ms Q states that on a routine blood test 7 years ago she was noted to
have a calcium level of 10.1 mg/dL (2.5 mmol/L). She has subsequently had
her calcium checked on a biannual basis and it has ranged from 10.4 to 11.3
mg/dL (2.6-2.8 mmol/L). Ms Q was referred to an endocrinologist in December
2002 after her calcium was higher than 11 mg/dL (2.7 mmol/L) on 3 occasions.
Her laboratory studies just prior to her visit revealed a calcium level of
11.1 mg/dL (2.8 mmol/L), a parathyroid hormone (PTH) level of 102 pg/mL, and
a phosphate level of 3.4 mg/dL.
Strewler GJ. A 64-Year-Old Woman With Primary Hyperparathyroidism. JAMA. 2005;293(14):1772-1779. doi:10.1001/jama.293.14.1772