Primary hyperparathyroidism and cancer

During the thirty-five year period from 1937 1973, 100 parathyroid tumors were found and pathologically proved at Memorial Hospital, New York. Ninety-one were found at surgery and nine at autopsy. There were eighty-seven functioning adenomas, one case of multiple adenomas or hyperplasia, and four parathyroid carcinomas. Hypercalcemia was documented in ninety-one patients and presented a serious diagnostic problem. One third of the patients had cancer either before, during, or after the discovery of hypercalcemia. Another third had a benign tumor coincidental with a parathyroid tumor. One third had the benign bone tumors and pathologic fractures of primary hyperparathyroidism itself. A survey of the same years at The New York Hospital revealed 180 cases of proved primary hyperparathyroidism wherein 10 per cent had cancer fortuitously. The sites of these tumors, multiplicity, histology, surgical management, and complications of treatment were analogous to the experience in the series at Memorial Hospital. The signs and symptoms of this disease have perceptibly changed over the years as diagnosis and detection have improved. The necessary laboratory studies have been progressively simplified and are more accurate. Surgical exploration is safe and necessary in early diagnosis and treatment.