The clinical recognition of hyperparathyroidism depends on interpretation of its protean manifestations. These have been divided into (1) those symptoms resulting from chemical alterations in the blood, (2) those symptoms resulting from involvement of the urinary tract and (3) those symptoms resulting from involvement of the skeleton. 1 At first the disease was recognized only in instances of far advanced skeletal disease. More recently a considerably larger group of cases have been reported in which renal symptoms predominated and skeletal involvement was minimal or absent. Albright, Aub and Bauer 2 have pointed out that hyperparathyroidism with bone disease may occur without evident renal lesions and that hyperparathyroidism with renal lesions can occur without bone involvement. It is therefore apparent that neither osseous nor renal lesions need necessarily be conspicuous in hyperparathyroidism. Keating and Cook 3 have mentioned one proved instance of hyperparathyroidism in which there was no evidence of bone