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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.
Lindsey ES. 'The Shrinking Man'. JAMA. 1981;245(2):129. doi:10.1001/jama.1981.03310270011011
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