Management of Primary Hyperparathyroidism: Historical and Contemporary Perspectives

Area of Science:

• Endocrinology
• Biochemistry
• Genetics

Background:

• Primary hyperparathyroidism (PHPT) is a common endocrine disorder, typically caused by parathyroid adenomas.
• Epidemiology and management of PHPT have evolved, with asymptomatic presentations now prevalent in developed nations due to biochemical screening.
• Normocalcemic PHPT presents a diagnostic challenge, requiring exclusion of secondary causes.

Purpose of the Study:

• To review the evolving epidemiology and management strategies for primary hyperparathyroidism.
• To highlight diagnostic considerations for normocalcemic PHPT and the role of genetic testing.
• To outline current treatment recommendations, including surgical and medical options.

Main Methods:

• Literature review of epidemiological trends and diagnostic criteria for PHPT.
• Analysis of current guidelines for surgical and medical management.
• Discussion of genetic testing utility in specific patient populations.

Main Results:

• Asymptomatic PHPT is the most common presentation in developed countries; symptomatic disease is decreasing globally.
• Genetic testing aids in differentiating PHPT from familial hypocalciuric hypercalcemia in select young patients.
• Many "asymptomatic" patients have undiagnosed complications like nephrolithiasis or vertebral fractures.

Conclusions:

• Surgery remains the primary treatment for symptomatic PHPT and selected asymptomatic cases.
• Medical management with cinacalcet and antiresorptive therapies is available for hypercalcemia and osteoporosis in non-surgical candidates.
• Comprehensive evaluation, including screening for complications, is crucial for optimal PHPT patient management.