Primary Hyperparathyroidism

Abstract

Background Primary hyperparathyroidism (PHPT), the most common cause of hypercalcemia, is most often identified in postmenopausal women. The clinical presentation of PHPT has evolved over the past 40 years to include 3 distinct clinical phenotypes each of which has been studied in detail and has led to evolving concepts about target organ involvement, natural history, and management. Methods In this review, I provide an evidence-based summary of this disorder as it has been studied world-wide citing key concepts and data that have helped to shape our concepts about this disease. Results Primary hyperparathyroidism is now recognized to include three clinical phenotypes: overt target organ involvement; mild asymptomatic hypercalcemia; and high PTH levels with persistently normal albumin-corrected and ionized serum calcium values. The factors that determine which of these clinical presentations is more likely to predominate in a given country include the extent to which biochemical screening is employed, vitamin D deficiency, and whether parathyroid hormone levels are routinely measured in the evaluation of low bone density or frank osteoporosis. Guidelines for parathyroidectomy apply to all three clinical forms of the disease. If surgical guidelines are not met, parathyroidectomy can also be an appropriate option if there are no medical contraindications. If either the serum calcium or bone mineral density is of concern and surgery is not an option, pharmacological approaches are available and effective. Conclusions Advances in our knowledge of primary hyperparathyroidism have guided new concepts in diagnosis and management.