Long-term health risk of primary hyperparathyroidism: the effect of surgery

Primary hyperparathyroidism is a common disease but 90% of sufferers remain undetected. In elderly women its prevalence is about 1%. The disease can cause severe hypercalcaemia and lead to life-threatening symptoms. However, the majority of cases represent milder forms of hyperparathyroidism with minimal symptoms or no symptoms at all, and slight hypercalcaemia which does not progress during follow-up. Surgery is the only effective treatment of primary hyperparathyroidism and most of the symptoms respond favourably to surgery. Nevertheless, the role of surgery has been controversial in the treatment of mini-symptomatic patients. Recently it has become evident that primary hyperparathyroidism is associated with increased mortality due mainly to cardiovascular diseases, and it has been shown that surgical treatment is able to diminish or even eliminate this risk of premature death. The extra mortality is connected also to the mild and nonprogressive forms of the disease, and it seems to have a strong correlation with the duration of the disease. This aspect favours active treatment at an early stage of the disease. Conservative treatment can be considered only in old patients with mild and stable clinical course. Primary hyperparathyroidism is an important risk factor causing morbidity and mortality.