Primary hyperparathyroidism. Update on pathophysiology, clinical presentation and surgical treatment

Area of Science:

• Endocrinology
• Molecular Biology
• Nephrology

Background:

• Parathyroid hormone (PTH) secretion is critical for calcium homeostasis.
• The calcium sensing receptor (CaR) on parathyroid cells is key to understanding parathyroid physiology and hyperparathyroidism.
• CaR-targeting drugs offer therapeutic potential for hyperparathyroidism and osteoporosis.

Purpose of the Study:

• To review current understanding of calcium homeostasis and the role of the CaR.
• To discuss the management of primary hyperparathyroidism, including asymptomatic and non-classical cases.
• To examine evolving surgical strategies for hyperparathyroidism.

Main Methods:

• Literature review of calcium homeostasis, CaR discovery, and hyperparathyroidism management.
• Analysis of clinical guidelines and controversies in hyperparathyroidism treatment.
• Discussion of advancements in preoperative localization and surgical approaches.

Main Results:

• CaR discovery has significantly improved understanding of parathyroid function and disease.
• Guidelines for asymptomatic hyperparathyroidism exist, but treatment for non-classical symptoms remains debated.
• Surgical strategies are shifting towards limited approaches based on improved localization, but long-term data are lacking.

Conclusions:

• The CaR is a crucial target for therapeutic development in metabolic bone diseases.
• Further research is needed to clarify the risks of primary hyperparathyroidism and optimize treatment strategies.
• Evidence-based validation of new surgical techniques for hyperparathyroidism is essential.