Primary Hyperparathyroidism: Pathology and Therapy

Edward Paloyan, MD; A. M. Lawrence, MD, PhD
JAMA. 1981;246(12):1344. doi:10.1001/jama.1981.03320120048030.
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More than 50 years ago, despite the controversy over whether parathyroid tumors were harmful or not, Felix Mandl, a steadfast and determined Viennese surgeon, made his decision to operate on the now famous Albert, a tramcar conductor who had been bedridden with osteitis fibrosa cystica involving much of his skeleton. The good news was that Albert "stopped excreting his skeleton into his urine" and within a few months after his parathyroidectomy was able to ambulate and return to a relatively normal life. The bad news was not long in manifesting itself; a year or two later, Albert noticed recurrence of his symptoms and finally agreed to a second operation, six years after the first. Unfortunately, it was unsuccessful and Albert succumbed to the musculoskeletal and metabolic ravages of hyperparathyroidism. A reasonable assumption is that Albert had either "double adenomas," diffuse adenomatous hyperplasia, or multiglandular parathyroid disease.

At least two lessons


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