With the realization of the almost ubiquitous presence of hyperparathyroidism in chronic renal failure, it seems inevitable that the recognition of the spectrum of the symptoms attributed to this condition should expand concomitantly. The usual indications for surgery in secondary hyperparathyroidism are persistent hypercalcemia, symptomatic progressive osteitis fibrosa cystica, and metastatic subcutaneous calcifications.1 We have recently performed subtotal parathyroidectomy on three patients because of manifestations other than the usual ones and wish to report the surgical consequences. A fourth patient is described to demonstrate the therapeutic efficacy of oral phosphate binding antacids for metastatic subcutaneous calcification.
One patient suffered from intractable pruritus without manifestations of hyperparathyroidism. The second had acute involuntary muscle contractions associated with hypercalcemia and pruritus. The third developed extensive vascular calcifications associated with the development of angina pectoris and a cardiac murmur. The fourth developed subcutaneous calcification while not taking oral phosphate binders, which interfered with