Diagnosis and management of asymptomatic primary hyperparathyroidism. National Institutes of Health Consensus...

The National Institutes of Health Consensus Development Conference on Diagnosis and Management of Asymptomatic Primary Hyperparathyroidism brought together endocrinologists, surgeons, radiologists, epidemiologists, and primary health care providers as well as the public to address indications for surgery in asymptomatic patients with hyperparathyroidism (HPT) and how patients not operated on should be monitored and managed to minimize the risk of complications of HPT. Following 1 1/2 days of presentations by experts and discussion by the audience, a consensus panel weighed the evidence and prepared their consensus statement. Among their findings, the panel concluded that (1) a diagnosis of HPT is established by demonstrating persistent hypercalcemia together with an elevated serum parathyroid hormone concentration; (2) current and acceptable treatment for HPT is surgery to cure the condition; (3) the diagnosis of HPT in an asymptomatic patient does not in all cases mandate referral for surgery; conscientious surveillance may be justified in patients whose calcium levels are only mildly elevated and whose renal and bone status are close to normal; and (4) preoperative localization in patients without prior neck operation is rarely indicated and not proven to be cost-effective.