It is generally accepted that some patients affected by mild asymptomatic
primary hyperparathyroidism need not be treated with surgery, but may be medically managed without risk. However, our experience regarding 5 of these cases observed in the last two years, suggests a different approach. These patients, initially diagnosed as having mild
hyperparathyroidism based on only moderately elevated serum concentrations of
calcium and followed medically for years, were referred to us for a sudden worsening of their
clinical course. One 35-year-old man presented hemorrhagic
gastritis with severe
anemia and type II
AV block with syncopal attacks. Three women, aged 51, 64 and 65 years, presented with severe
hypercalcemia associated with
renal failure in two and with marked
bone disease in another. In all these cases
parathyroid neoplasms were preoperatively localized (by ultrasonography, CT scan and radioactive 201-
Tl 99-Tc scan) and surgically removed. Histological examination showed a
parathyroid carcinoma in the male patient and single gland enlargements in the three females. A fifth patient, a 65-year-old woman, was referred to us in critical condition: severe
hypercalcemia,
osteopenia with femur fracture,
myocardial infarction and
renal failure. She died in a few days, in spite of intensive medical care. These cases suggest that patients with
hyperparathyroidism initially diagnosed as "mild" need close medical observation and preferably, in our opinion, should undergo surgery.