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May 20, 1974


Author Affiliations

Massachusetts General Hospital Boston
University of California Medical Center San Francisco

JAMA. 1974;228(8):1038. doi:10.1001/jama.1974.03230330068032

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This provocative monograph on hyperparathyroidism presents such a unique point of view that an appropriate title should be "Facts, Concepts, and Speculations Regarding Hyperparathyroidism." The text vacillates from solid, proved, established facts to mere speculation in such a manner that the reader might be unaware that the proven substantiation is lacking. The authors report a high incidence of hyperplasia (79%)— with or without adenoma—while they find a single adenoma in only 19%! They imply that normocalcemic hyperparathyroidism, with or without nephrolithiasis, is common. They were led to these conclusions by microscopic examination of parathyroid glands previously considered normal but now deemed hyperplastic. They also cite a high recurrence rate (30%) after the removal of a single adenoma whereas most medical centers report an incidence of 5% or less. They therefore recommend the removal of 3 1/2 parathyroid glands in hyperparathyroidism in order to prevent recurrence. They conclude that the apparently