The MTS provides information that extends beyond its immediate usefulness as a prioritisation mechanism. It is a powerful tool for distinguishing between patients with high and low unadjusted risk of short-term death as well as those who will stay in hospital for at least 24 h and those who will return home. Its discriminatory power is not equal for medical and surgical specialities, which may be linked to the nature of its inbuilt discriminators.

Ž. Primary hyperparathyroidism HPT is associated with generalized skeletal changes, its full-blown osseous manifestations known as Ž . osteitis fibrosa cystica. Fibrous dysplasia FD , a benign bone disorder, is differentiated from generalized fibrocystic disease caused by hyperparathyroidism. The classic triad of McCune-Albright syndrome includes polyostotic FD, patchy skin pigmentation, and sexual precocity. Other associated endocrinopathies are hyperthyroidism, Cushing's syndrome, acromegaly, and HPT. We describe a patient with severe generalized and focal bone lesions and sexual precocity. HPT was diagnosed and treated with persistence of cystic bone lesions. The similarities between HPT and FD are discussed, focusing on a possible genetically determined mechanism to explain the relationship between them. q