This Journal feature begins with a case vignette highlightinga common clinical problem. Evidence supporting various strategiesis then presented, followed by a review of formal guidelines,when they exist. The article ends with the authors' clinicalrecommendations.
A 60-year-old woman is noted incidentally to have a calciumlevel of 10.8 mg per deciliter (2.70 mmol per liter; normalrange, 8.4 to 10.2 mg per deciliter [2.10 to 2.55 mmol per liter]).The parathyroid hormone level, as measured on immunoradiometricassay, is 84 pg per milliliter (normal range, 10 to 65). Shehas never had a kidney stone or a . . . [Full Text of this Article]
The Clinical Problem
Strategies and Evidence
Diagnosis
Natural History of Asymptomatic Primary Hyperparathyroidism without Surgery
Outcomes after Parathyroid Surgery
Areas of Uncertainty
Long-Term Risks
Medical Therapy
Calcium and Vitamin D Intake
Other Uncertainties
Guidelines
Conclusions and Recommendations
Source Information
From the Departments of Medicine (J.P.B., S.J.S.) and Pharmacology (J.P.B.), College of Physicians and Surgeons, Columbia University, New York.
Address reprint requests to Dr. Bilezikian at the Department of Medicine, College of Physicians and Surgeons, 630 W. 168th St., New York, NY 10032.
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