Hyperparathyroidism—epidemic or endemic?

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DURING the eleven-month period between January 1 and December 1, 1969, 25 operations for hyperparathyroidism were performed at the Cleveland Clinic Hospital. In the previous year, 11 were performed, and a decade ago only five were done (Fig. 1).

Why has the incidence of operations for hyperparathyroidism increased so strikingly? Does this represent an epidemic or is it a local phenomenon? What have we learned from our increasing experience in the diagnosis and treatment of the disease?


Secondary hyperparathyroidism is distinguished from primary in that usually the serum calcium is not increased in the former. The patient has an underlying condition that is causing the hyperparathyroidism, such as chronic renal failure. If the secondary hyperparathyroidism becomes autonomous, it is said to be tertiary hyperparathyroidism and usually the serum calcium is increased.

Causes of increasing incidence of hyperparathyroidism

Increased diagnosis by means of SMA-12. In 1968, the Cleveland Clinic installed a 12-channel AutoAnalyzer (SMA-12) that is able to analyze a sample of blood for 12 chemical constituents as fast and as economically as in the past had been done for any two constituents. Within a few months the staff physicians appreciated the advantages of this broad-spectrum type of chemical examination and began to make use of its vast potential. By January 1969, 200 blood samples a day, six days a week, were being analyzed in the SMA-12 for calcium and 11 other constituents. This volume of analyses is in contrast to 20 calcium determinations daily in 1967, when a calcium . . .



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