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To the Editor:—
There was no intent on my part to imply that hyperparathyroidism might be at the basis of the patient's symptoms. My reason for not including the disorder was the absence of the usual clinical manifestations and laboratory findings. You will note that my answer makes reference to "equivocal laboratory results." Though I was aware of the slight rise in serum calcium (12 mg.%), I could not interpret the significance of this slight change in view of the normal serum inorganic phosphate level (3.7 mg.%). Dr. Hunter may be correct in not dismissing this so readily, since a high phosphorus intake or renal impairment, factors which we do not know about in this patient, conceivably could mask a hypophosphatemia. None of the patient's symptoms resemble those of hyperparathyroidism. Indeed, the muscle tightness complained of is opposite to the usual muscle flaccidity and weakness. As I stated in my
Schumacher GA. Bizarre Clinical Findings-Reply. JAMA. 1962;180(3):262–263. doi:10.1001/jama.1962.03050160078028
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