Unfortunately, the diagnosis of hyperparathyroidism still rests on the demonstration of the chemical and pathologic effects of a sustained excess of parathyroid hormone(s) rather than the direct measurement of the hormone itself. Osteitis fibrosa and/or subperiosteal bone reabsorption, nephrocalcinosis, and lithiasis may or may not be clinically (radiologically) evident. Hypercalcemia and hypophosphatemia, the typical chemical abnormalities, may not always be present together. The diagnosis of hyperparathyroidism, therefore, often becomes one of exclusion by ruling out other hypercalcemic disorders.
The present case represents the approach to the problem in a patient with either hyperparathyroidism, Paget's disease, or metastatic carcinoma of the breast, or any combination of these disorders.
The patient was a 78-year-old white woman who entered the hospital on her final admission because of three syncopal attacks over the preceding four-month period, the final attack having occurred two days prior to admission. Following this she remained lethargic and
ROCKNEY RE, KLEEMAN CR, MAXWELL MH. Hyperparathyroidism in a Patient with Paget's Disease and Carcinoma of the Breast. AMA Arch Intern Med. 1959;104(5):797–801. doi:10.1001/archinte.1959.00270110117016
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