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Previous Volume 359:1183-1184 September 11, 2008 Number 11 Next

	Since this article has no abstract, we have provided an extract of the first 100 words of the full text and any section headings.

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To the Editor: The diagnosis of secondary hyperparathyroidism in the case discussed by Demay and colleagues (May 22 issue)¹ is doubtful. Primary hyperparathyroidism with coexisting vitamin D deficiency presents with normocalcemia and hypophosphatemia.² Hence, a normal calcium level with a low phosphorus level is not diagnostic of secondary hyperparathyroidism. The features of bone pain and fatigue, brown tumor, lytic bone lesions, and a single parathyroid adenoma are all suggestive of primary hyperparathyroidism. The markedly elevated level of parathyroid hormone suggests a secondary cause but does not rule out primary hyperparathyroidism³; a markedly decreased level of the calcium-sensing receptor is . . . [Full Text of this Article]

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