Screening for Primary Hyperparathyroidism

Excerpt

To the editor: We agree with Heath (1) that most patients with primary hyperparathyroidism discovered as a result of multichannel biochemical screening would not otherwise have been identified; in our experience, the proportion of such patients who have no symptoms is considerably higher than 50%. But we disagree that the need for surgery has been clearly established.

Among the "compelling reasons" mentioned is an adverse effect on bone, but although patients with mild hyperparathyroidism have lost too much appendicular cortical bone, they are no longer losing bone faster than expected (2). Furthermore, the prevalence of vertebral deformation on radiographs is