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January 9, 1981

'The Shrinking Man'

JAMA. 1981;245(2):129. doi:10.1001/jama.1981.03310270011011

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To the Editor.—  Horensten and his colleagues (1980;244:267) have recounted, in their report entitled "The Shrinking Man: A Manifestation of Severe Renal Osteodystrophy," a dilemma that was altogether too common in the early experience with long-term hemodialysis. I would respectfully and sympathetically submit that a second exploration for recurrent hyperparathyroidism should never be undertaken without selective venous sampling for parathyroid hormone assays. Probably their patient's fifth (or even sixth) parathyroid is in his mediastinum.