The diagnosis, occurrence and clinical aspects of primary hyperparathyroidism in patients with recurrent urolithiasis as registered in general practice.
Five patients with primary hyperparathyroidism (surgically verified) and one patient with probable normocalcaemic hyperparathyroidism were diagnosed in a series of 93 recurrent stone formers in general practice. The six case histories are presented. The initial diagnosis was based on repeated albumin corrected total serum calcium determinations. The condition had previously not been diagnosed in four of the six patients, despite one or more hospital admissions. The urinary calcium excretion index ad modum Peacock & Nordin is not recommended as a routine test for use in general practice. Serum immunoreactive parathyroidal hormone related to simultaneous serum calcium values did not give any further diagnostic information in 48 of these patients with, or without, formation of new stones during a mean follow-up period of 3.2 years. The clinical spectrum of primary HPT has apparently shifted during the last three decades from bone disease and renal calculi to more general symptoms.