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May 16, 1977

Asymptomatic Hyperparathyroidism

Author Affiliations

College of Physicians and Surgeons New York

JAMA. 1977;237(20):2186-2187. doi:10.1001/jama.1977.03270470022004

To the Editor.—  The widespread use of multichannel screening tests has been responsible for identifying an increasingly large group of patients with mild hypercalcemia and no symptoms. These patients often present a therapeutic problem, because it is not known in which ones progressive disease will develop and in ones there will be no symptoms. Kosinski and colleagues (236:590, 1976) have recently described 31 years of welldocumented primary hyperparathyroidism in a patient who remained asymptomatic during this period. Other isolated reports have confirmed that there appears to be a subset of patients with primary hyperparathyroidism whose natural history is not associated with progressive targetorgan dysfunction.In contrast, we recently cared for a patient whose case illustrates that long-standing primary hyperparathyroidism may be progressive although she was asymptomatic for more than three decades.

Report of a Case.—  A female patient was admitted to the Stamford Hospital on three separate occasions in 1943