Increased Spinal Fluid Protein in Hyperparathyroidism and Other Hypercalcemic States

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Abstract
The finding of hypercalcemia is usually considered adequate explanation for otherwise unexplained central nervous system manifestations, as indicated by Fitz,1 Bogdonoff,2 and others.3,4 Recently, however, the medical service of this hospital was faced with the problem of a patient with hypercalcemia and disordered central nervous system function who also had significantly increased cerebrospinal fluid (CSF) protein. This latter finding directed the investigators away from the proper diagnosis of hyperparathyroidism and from the resolution to perform emergency surgical exploration of the neck. The patient died during the period of diagnostic study, and at autopsy he was found to have two parathyroid adenomas with no other cause for the CSF abnormality. We have since observed another patient with hypercalcemia, secondary to carcinoma of the pancreas, and central nervous system manifestations, who also had increased CSF protein. Our experience with these cases is being reported, together with a review of

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