Primary hyperparathyroidism

Abstract

In this Review, we describe the pathogenesis, diagnosis and management of primary hyperparathyroidism (PHPT), with a focus on recent advances in the field. PHPT is a common endocrine disorder that is characterized by hypercalcaemia and elevated or inappropriately normal serum levels of parathyroid hormone. Most often, the presentation of PHPT is asymptomatic in regions of the world where serum levels of calcium are routinely measured. In addition to mild hypercalcaemia, PHPT can manifest with osteoporosis and hypercalciuria as well as with vertebral fractures and nephrolithiasis, both of which can be asymptomatic. Other clinical forms of PHPT, such as classical disease and normocalcaemic PHPT, are less common. Parathyroidectomy, the only curative treatment for PHPT, is recommended in patients with symptoms and those with asymptomatic disease who are at risk of progression or have subclinical evidence of end-organ sequelae. Parathyroidectomy results in an increase in BMD and a reduction in nephrolithiasis. Various medical therapies can increase BMD or reduce serum levels of calcium, but no single drug can do both. More data are needed regarding the neuropsychological manifestations of PHPT and the pathogenetic mechanisms leading to sporadic PHPT, as well as on risk factors for complications of the disorder. Future work that advances our knowledge in these areas will improve the management of the disorder.

Conflict of interest statement

Competing interests statement

The authors declare no competing interests.

Figures

Figure 1 |. Relationship between serum levels of calcium and PTH.

Depicted is the relationship between serum levels of calcium and PTH in patients with primary hyperparathyroidism (PHPT; red line) and normal individuals (blue line). PHPT results in a shift of the curve to the right. Increased levels of calcium are needed to suppress PTH levels in PHPT.

Figure 2. Trabecular deterioration in PHPT.

High-resolution peripheral quantitative CT images of the radius in a patient with primary hyperparathyroidism (PHPT; left) and a normal control (right). Trabecular deterioration is evident in PHPT. Reproduced with permission from REF 67, John Wiley and Sons.