Primary Hyperparathyroidism With 31 Years of Hypercalcemia

BIOCHEMICAL screening during the course of routine medical examinations has led to the discovery of increasing numbers of patients with asymptomatic primary hyperparathyroidism.1,2There is a paucity of clinical data as to the natural history of primary hyperparathyroidism, and though recent studies,2,3as well as Robert Neer, MD, in an oral communication (Jan 2, 1976), have indicated that a significant number of these patients may be observed without danger, many physicians feel obligated to operate on these asymptomatic individuals in order to correct the biochemical abnormality. There have been numerous reports of patients whose first symptom of primary hyperparathyroidism, usually a renal stone, has occurred as much as 40 years prior to the establishment of the diagnosis of primary hyperparathyroidism and the treatment of this disease.4,5Fahey and Meyers6reported a patient with chemically proved hypercalcemia of 36 years' duration that persisted 30 years after removal