Rib Cage Deformity in Neonatal Hyperparathyroidism

Sir .—We were very interested in the article, "Neonatal Primary Hyperparathyroidism in Familial Hypocalciuric Hypercalcemia," by Matsuo et al (Journal1982;136:728-731), particularly by the initial finding of respiratory distress contributed by rib cage deformity. We report a case of neonatal hyperparathyroidism with rib cage deformity similar to "asphyxiating thoracic dysplasia." Report of a Case .—We observed a female neonate born at term, weighing 2,900 g. She was transferred to our hospital at the age of 16 hours because of respiratory distress. Examination showed an extremely narrow chest that resembled asphyxiating thoracic dysplasia. A chest roentgenogram showed thin, short, and demineralized ribs. A roentgenogram of the skeleton confirmed generalized demineralization. Laboratory data included a serum calcium concentration of 11.2 mg/dL, a serum phosphate level of 5.5 mg/dL, and serum alkaline phosphatase level of 450IU. Urinary excretion of calcium, phosphate, and cyclic adenosine monophosphate were 5 mg/day, 155 mg/day, and 21 nmole/mg