To the Editor In a recent issue of JAMA Internal Medicine, Alore et al1 report the rates of diagnosis and surgical interventions among patients experiencing parathyroid-related hypercalcemia, namely primary hyperparathyroidism (pHPT). They conclude that pHPT is rarely diagnosed and, thus, most patients do not undergo parathyroidectomy, the only procedure that leads to recovery and that prevents both bone and kidney complications. To avoid spurious diagnoses, Alore et al1 used the combination of hypercalcemia and elevated circulating level (greater than the reference range) of parathyroid hormone (PTH) as a definition for pHPT, excluding 90 290 of 149 737 patients (more than 60% of their cohort) who had PTH values within the normal range. The rate of this biological combination increased over time (from 2000 to 2015), as the rate of parathyroidectomies decreased. Nevertheless, as mentioned by Alore et al,1 pHPT incidence is probably even higher nowadays: up to 50% of all patients experiencing pHPT now present to clinicians with PTH levels within the normal range.2,3
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Bertocchio J. Diagnosis and Management of Hyperparathyroidism. JAMA Intern Med. 2019;179(12):1732. doi:10.1001/jamainternmed.2019.5084
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