Primary Hyperparathyroidism: An Overview

Abstract

Primary hyperparathyroidism is a common condition that affects 0.3% of the general population. Primary and tertiary care specialists can encounter patients with primary hyperparathyroidism, and prompt recognition and treatment can greatly reduce morbidity and mortality from this disease. In this paper we will review the basic physiology of calcium homeostasis and then consider genetic associations as well as common etiologies and presentations of primary hyperparathyroidism. We will consider emerging trends in detection and measurement of parathyroid hormone as well as available imaging modalities for the parathyroid glands. Surgical indications and approach will be reviewed as well as medical management of primary hyperparathyroidism with bisphosphonates and calcimimetics.

Diagnosis and management of primary hyperparathyroidism: a scientific statement from the Department of Bone Metabolism, the Brazilian Society for Endocrinology and Metabolism

“…Hypercalcemia with very low or undetectable plasma PTH levels is present in malignant diseases in which case PTHrP is often responsible for serum calcium elevation (33,37).…”

“…Studies evaluating different skeleton sites through different methods (three-dimensional analysis of bone biopsy using micro-computerized tomography, conventional two-dimensional bone histomorphometry and quantitative electron imaging) showed differences in the effects of PHPT on the trabecular bone (33,51,60,61).…”

The value and role of low dose methylene blue in the surgical management of hyperparathyroidism

“…This can be attributed to two main factors: increased screening for raised calcium and an ageing population in whom the disease is more prevelant, particularly affecting postmenopausal women. 10 The current series highlights the benefits and advantages of MB infusion in patients undergoing minimally invasive as well as open surgery. MB aids efficient and rapid identification of abnormal glands in eutopic and, especially, in ectopic locations in the neck.…”

Tumor Pardo Multifocal Como Manifestación Del Hiperparatiroidismo Primario Por Adenoma Paratiroideo Asociado a Carcinoma Papilar De Tiroides

“…La paratohormona es una hormona proteica secretada por las glándulas paratiroides cuya principal función es la regulación de la homeostasis del calcio, su sobreproducción a partir de una o varias glándulas produce hipercalcemia; este estado de hiperparatiroidismo es la tercera endocrinopatía más común y afecta al 0,3% de la población en general y a 1-3% de las mujeres posmenopáusicas 1,2 .…”

“…En EEUU la incidencia de hiperparatiroidismo ha ido en aumento, esto debido a la modernización de técnicas de dosificación sanguínea de calcio sérico, a cerca de 22 casos por 100.000 personas por año 1,3 . En el 85 a 95% de los casos el hiperparatiroidismo es producido por un adenoma paratiroideo, mientras que el 5-10% es producido por enfermedad multi-glandular y en menos del 1% por el carcinoma paratiroideo 4 .…”