THE DIAGNOSIS OF HYPERPARATHYROIDISM*

Abstract

The clinical diagnosis of hyperparathyroidism depends largely on the alert clinician and consultant who are aware of the protean manifestations of this disease. Serum calcium levels, when normal, usually exclude the diagnosis of overt hyperparathyroidism. We recommend further investigations in patients with a borderline serum calcium level. A reasonable approach would be to follow these patients with urinary phosphorus studies, stressed by either calcium infusion or phosphate deprivation. If these efforts to augment and thus demonstrate the abnormality are not successful, serial serum calcium determinations should follow. Although investigators proposed many other techniques in the past, it is not reasonable to attempt the total gauntlet of diagnostic procedures on every suspected individual. In regard to the radiologic manifestations, the sine qua non for the diagnosis is subperiosteal cortical erosion. Osteoporosis and osteomalacia probably occur in all patients with hyperparathyroidism, but may not be clinically evident until the disease is quite advanced. Renal calculi, particularly if associated with pancreatic calculi, should suggest this disease. Soft tissue, including vascular, calcification is more often seen with secondary hyperparathyroidism.