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To the Editor:—
In the May 31 issue of The Journal (192:782, 1965) there was an interesting article entitled "Hypercalcemia Secondary to a Primary Hepatoma" by Drs. Keller, Goldschneider and Lafferty. The authors incorrectly stated that "... this appears to be the first reported case of hypercalcemia associated with a primary hepatoma in the absence of skeletal metastases."The association of hypercalcemia and primary hepatoma was described by Becker et al 20 months ago in The Journal (186:1018, 1963). The hepatoma was associated not only with hypercalcemia and hypercalciuria but also with polycythemia and symptomatic hypoglycemia. Multiple alterations in metabolism were possibly determined by the primary tumor. Incomplete postmortem studies could not exclude a parathyroid adenoma as the cause of the hypercalcemia. The case of Keller et al has the advantage of a complete and detailed postmortem examination which excluded the existence of a parathyroid adenoma or osseous metastases.
Hadziyannis J, Merikas GE. Second—Not First Reported Case. JAMA. 1965;193(13):1128. doi:10.1001/jama.1965.03090130056026
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