[Coronary heart disease as the initial manifestation of primary hyperparathyroidism].

Due to unstable angina pectoris coronary arteriography was performed in a 57 year-old female, showing diffuse 3-vessel disease; aortocoronary bypass surgery was recommended. During routine pre-operative examination hypercalcemia, as well as an elevated value of parathormone were observed. Ultrasonography of the parathyroid glands showed two enlarged cranial glands. In a simultaneous surgical procedure 4 bypass grafts were performed and 4 hyperplastic parathyroid glands were removed, one of which was re-operated as an autotransplantation in the left musculus adductor magnus. Histological examination showed water clear cell hyperplasia of the parathyroid glands. Though the patient had suffered from stomach and duodenal ulcers and nephrolithiasis over several years, primary hyperparathyroidism was diagnosed only after angiographically proven coronary artery disease.