Clinical Problem-Solving: Stopping Short of Certainty

Roger A. Fisken, Jamie S. Lieberman, James J. O'connor, Herbert Patrick, Abid Assali, Yitzhak Beigel, Menahem Fainaru, Michael Siebels, Robert A. Kreisberg

Research output: Contribution to journalLetterpeer-review


To the Editor: In the Clinical Problem-Solving exercise on hypercalcemia (July 7 issue),1 I disagree with Dr. Kreisberg's comment, made more than once, that the diagnosis of primary hyperparathyroidism can be ruled out at an early stage. I submit that this is not the case at all. It is important in any differential diagnosis to bear in mind at the outset that common disorders occur commonly, and the initial diagnostic approach should be based on this principle. The clinical history recounted in the first paragraph is extremely suggestive of primary hyperparathyroidism; in contrast, steroid-responsive vitamin D-mediated hypercalcemia is extremely uncommon…

Original languageEnglish
Pages (from-to)1456-1458
Number of pages3
JournalNew England Journal of Medicine
Issue number21
StatePublished - 24 Nov 1994
Externally publishedYes


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