Historical Perspective

Osteitis fibrosa cystica was first described in the 18th century, although not so named until 1891, when von Recklinghausen reported three patients with giant cell pseudotumor of the bone.1 Interestingly, one of these patients had a "reddish brown lymph node" below the thyroid. In 1925, Felix Mandl successfully removed a parathyroid adenoma from the neck of a patient suffering from von Recklinghausen's disease.2 Between 1925 and 1932, all patients operated on for primary hyperparathyroidism (1° HPT) had the bone manifestations of osteitis fibrosa cystica. In 1932, however, Albright noted that 80% of all patients with 1° HPT treated at that time had nephrolithiasis. He wondered whether some patients might have renal stones without bone disease. In 1932, he found a patient who presented with renal calculi without significant bone disease, in whom a parathyroid adenoma was found at operation.3 Over the next 30 years, as clinicians recognized nephrolithiasis as a manifestation of 1° HPT, the incidence of von Recklinghausen's bone disease declined and most patients with 1° HPT were found to have renal calculi alone or in combination with other early signs of bone disease such as the presence of subperiosteal erosions. Until the mid-1960s, clinically apparent 1° HPT was considered to be relatively uncommon. Occasionally, however, 10 HPT was sometimes discovered by serendipity in patients with an elevated serum calcium level.4 With the advent in the 1960s of autoanalyzers and routine screening of serum calcium levels, the prevalence of HPT increased to 0.1% to 0.4% as more patients with fewer clinical manifestations of the disease were diagnosed.5

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