Primary Hyperparathyroidism: A Narrative Review of Diagnosis and Medical Management

Abstract

Primary hyperparathyroidism (PHPT) is the most common cause of hypercalcemia in the outpatient setting. Symptomatic presentation includes non-specific signs and symptoms of hypercalcemia, skeletal fragility, nephrolithiasis and nephrocalcinosis. The majority of individuals present at an asymptomatic stage following routine biochemical screening, without any signs or symptoms of calcium or parathyroid hormone (PTH) excess or target organ damage. Indications for surgery have recently been revised as published in recent guidelines and consensus statements. Parathyroidectomy is advised in patients younger than 50 years old and in the presence of either significant hypercalcemia, impaired renal function, renal stones or osteoporosis. Surgery is always appropriate in suitable surgical candidates, however, medical management may be considered in those with mild asymptomatic disease, contraindications to surgery or failed previous surgical intervention. We summarized the optimal medical interventions available in the care of PHPT patients not undergoing parathyroidectomy. Calcium and vitamin D intake should be optimized. Antiresorptive therapy may be used for skeletal protection in patients with an increased fracture risk. Cinacalcet, a calcimimetic agent, has been shown to effectively lower serum calcium and PTH levels. The effect of medical treatment on the reduction in fracture risk is unknown and should be the focus of future research.

The Effect of the Frequently Used Cinacalcet for pHPT during the COVID-19 Pandemic on Perioperative Decrease in Parathyroid Hormone

“…Elective parathyroidectomy for pHPT has been frequently postponed in the era of the COVID-19 pandemic, and the European endocrinology guidelines proposed that cinacalcet should be considered as a bridging therapy while operation capacity is reduced [ 14 ]. However, calcimimetic therapy has increasingly been reported to be useful in improving preoperative biochemical parameters in pHPT even before the COVID-19 pandemic [ 12 , 15 ]. The drop in efficacy of this therapy, and sometimes its biochemical normalization, was reported in the results of a randomized controlled study and a systemic review [ 16 , 17 ].…”

Primary Hyperparathyroidism in Pregnancy: Literature Review of the Diagnosis and Management

“…Family history of parathyroid disease, MEN and FHH should also be addressed. In the setting of hypercalcemia, it is crucial to exclude other underlying conditions that can cause hypercalcemia, namely granulomatous disease, occult malignancy or adrenal insufficiency [60,65]. Hypercalcemia resulting from these conditions is non-PTH-mediated and therefore, PTH is expected to be suppressed.…”

Development and validation of a nomogram for risk prediction of nephrolithiasis recurrence in patients with primary hyperparathyroidism

“…Parathyroid dysfunction is the main cause of PHPT, with excessive release of parathyroid hormone (PTH) and disorder of normal regulation. As a result of increased level of PTH, the homeostasis of calcium and phosphate is disrupted, which leads to hypercalcemia through increased renal tubular calcium reabsorption ( 4 ). While hypercalcemia is a contributing factor in stone formation, the kidney is a principal target of PHPT, resulting in nephrolithiasis.…”