[Definition of hyperparathyroidism and indication for surgical therapy]

Parathyroid excess may happen as a result of autonomous overactivity of the parathyroid glands (primary hyperparathyroidism). Secondary hyperparathyroidism is the consequence of chronic hypocalcemia, leading to parathyroid hyperplasia. Long-lasting secondary hyperparathyroidism may turn to autonomy in the sense of tertiary hyperparathyroidism. In primary hyperparathyroidism indications for surgical intervention are renal, intestinal or osseous organ manifestations, as well as relevant clinical symptoms of the so-called hypercalcemic syndrome. In truly asymptomatic primary hyperparathyroidism, observation is justified. However, the patients need regular supervision. If there is progression indicating health risk, the strategy must switch from observation to operation. Secondary hyperparathyroidism has must be treated by surgery if renal osteodystrophy progresses or tertiary hyperparathyroidism develops.