Primary hyperparathyroidism: epidemiology, clinical features, diagnostic tools and current management

Abstract

Primary hyperparathyroidism (PHPT) is a disease caused by overactive secretion of parathyroid hormone (PTH) with a concurrent alteration of the phosphocalcemic metabolism: commonly we found an association between hypercalcemic status and elevated PTH plasma levels or not properly normal. Widespread screening of serum calcium introduced in the 70's has made PHPT a relatively common disease: in these cases hypercalcemia is quickly diagnosed and in the western world the disease tends to appear with not specific symptoms such as fatigue mood disturbance and cognitive impairments.1 The main cause is represented by a solitary parathyroid adenoma (80-85% of cases) (Figure 1): the remaining 15-20% of cases are represented by conditions of diffuse glandular hyperplasia ( Figure 2) and multiple adenomas. A small percentage of patients presents with typical familial forms of multiple endocrine neoplasia type 1 (MEN 1) and multiple endocrine neoplasia type 2 (MEN 2) syndromes.2,3 Primary hyperparathyroidism generally occurs with higher rate in a population older than 55 years: it occurs 2-3 times more frequently in women than in men and has a higher prevalence in postmenopausal women. Approximately 80% of patients with PHPT are asymptomatic being the asymptomatic hypercalcemic form the most representative: signs and symptoms, when present, are due to prolonged hypercalcemic status than to elevate serum levels of PTH. 4,5 The clinical manifestation remains variable ranging from the normocalcemic to the hypercalcemic PHPT form. 6,7 Methods of research ABSTRACTPrimary hyperparathyroidism (PHPT) is a clinical condition characterized by overactive parathyroid gland secretion of parathyroid hormone with concurrent alteration of the phosphocalcemic metabolism. We present a literature review on primary hyperparathyroidism addressing key on clinical presentation, causes, medical and surgical treatment at the best of our knowledge. Based on this review we confirm the role of serum calcium and serum level examination, as well as we define the definitive treatment for PHPT being parathyroidectomy. In case of contraindication for surgery, medical treatment can play a relevant role.

Imaging methods of the parathyroid glands in primary hyperparathyroidism. Literature review

“…По данным эпидемиологических исследований по всему миру, ежегодная заболеваемость для обоих полов составляет около 20-30 случаев на 100 000 населения в год. Распространенность в общей популяции -0,5-1%, увеличивается с возрастом (старше 50 лет) до 2% и более, с преобладанием женского пола в структуре заболеваемости (в соотношении, приближающемся к 4:1) [13][14][15][16][17][18].…”

Sub-acute physical and mental decline associated with abnormally hypercalcemia: the case report of an oldest-old woman saved by surgery

“…Primary hyperparathyroidism is a disease involving a broad range of alterations, mainly calcium homeostasis, sustained by parathyroid hormone (PTHi) levels that are abnormally elevated. Case studies worldwide show an annual incidence of 20 cases per 100.000 people with an estimated prevalence in the general population of 0.5% to 1%, increasing with age over 2% in both sexes [1]. Several patients with primary hyperparathyroidism are asymptomatic or experience mild symptoms related to chronic hypercalcaemia rather than increased parathyroid hormone [1].…”

“…Case studies worldwide show an annual incidence of 20 cases per 100.000 people with an estimated prevalence in the general population of 0.5% to 1%, increasing with age over 2% in both sexes [1]. Several patients with primary hyperparathyroidism are asymptomatic or experience mild symptoms related to chronic hypercalcaemia rather than increased parathyroid hormone [1]. Symptomatic primary hyperparathyroidism is a sporadic disease, mainly occurring after the age of 50 with a ratio between man and women from 1:3 to 1:5.…”