Presentation of Asymptomatic Primary Hyperparathyroidism: Proceedings of the Third International Workshop
Open Access
- 1 February 2009
- journal article
- review article
- Published by The Endocrine Society in Journal of Clinical Endocrinology & Metabolism
- Vol. 94 (2), 351-365
- https://doi.org/10.1210/jc.2008-1760
Abstract
Background: At the Third International Workshop on Asymptomatic Primary Hyperparathyroidism (PHPT) in May 2008, recent data on the disease were reviewed. We present the results of a literature review on issues arising from the clinical presentation and natural history of PHPT. Methods: Questions were developed by the International Task Force on PHPT. A comprehensive literature search for relevant studies was reviewed, and the questions of the International Task Force were addressed by the Consensus Panel. Conclusions: 1) Data on the extent and nature of cardiovascular involvement in those with mild disease are too limited to provide a complete picture. 2) Patients with mild PHPT have neuropsychological complaints. Although some symptoms may improve with surgery, available data remain inconsistent on their precise nature and reversibility. 3) Surgery leads to long-term gains in spine, hip, and radius bone mineral density (BMD). Because some patients have early disease progression and others lose BMD after 8–10 yr, regular monitoring (serum calcium and three-site BMD) is essential in those followed without surgery. Patients may present with normocalcemic PHPT (normal serum calcium with elevated PTH concentrations; no secondary cause for hyperparathyroidism). Data on the incidence and natural history of this phenotype are limited. 4) In the absence of kidney stones, data do not support the use of marked hypercalciuria (>10 mmol/d or 400 mg/d) as an indication for surgery for patients. 5) Patients with bone density T-score −2.5 or less at the lumbar spine, hip, or distal one third radius should have surgery.Keywords
This publication has 103 references indexed in Scilit:
- The Natural History of Primary Hyperparathyroidism with or without Parathyroid Surgery after 15 YearsJournal of Clinical Endocrinology & Metabolism, 2008
- Carotid artery plaque thickness is associated with increased serum calcium levels: The Northern Manhattan studyAtherosclerosis, 2007
- Preserved three-dimensional cancellous bone structure in mild primary hyperparathyroidismBone, 2007
- Medical Observation, Compared with Parathyroidectomy, for Asymptomatic Primary Hyperparathyroidism: A Prospective, Randomized TrialJournal of Clinical Endocrinology & Metabolism, 2007
- Parathyroidectomy improves neurocognitive deficits in patients with primary hyperparathyroidismSurgery, 2005
- A controlled, prospective study of neuropsychological outcomes post parathyroidectomy in primary hyperparathyroid patientsClinical Endocrinology, 2004
- Health-related quality of life in hyperparathyroidism measurably improves after parathyroidectomySurgery, 2003
- Cohort study on effects of parathyroid surgery on multiple outcomes in primary hyperparathyroidismBMJ, 2003
- A 10-Year Prospective Study of Primary Hyperparathyroidism with or without Parathyroid SurgeryThe New England Journal of Medicine, 1999
- Primary HyperparathyroidismThe New England Journal of Medicine, 1980