Focus on Primary Hyperparathyroidism – Diagnosis, Management and the Role of Calcimimetics

Primary Hyperparathyroidism – An Evolving Disorder

Primary Hyperparathyroidism – An Evolving Disorder
Primary hyperparathyroidism (HPT) is a common endocrine disease characterised by inappropriately high serum levels of parathyroid hormone (PTH) and elevated calcium.Indeed, it is the leading cause of hypercalcaemia in outpatients. Depending on severity, it may be accompanied by hypercalcaemic symptoms, nephrolithiasis, hyperparathyroid bone disease, loss of bone mineral density (BMD) and neuromuscular weakness.The main pathologies underlying the disorder are parathyroid adenoma (~85%), hyperplasia (~15%) or carcinoma (~<1%). Data suggest that the incidence of primary HPT increases with age in both sexes, with a peak occurring in women after 50 years of age. The introduction of routine biochemical screening in the 1970s had a substantial impact on the presentation of primary HPT, changing the clinical profile from kidney stones and overt bone disease to a less defined, more asymptomatic state in those regions where routine screening is available (see Figure 1). Rates of detection have increased correspondingly, with an initial five-fold rise in the number of patients diagnosed with primary HPT, reflecting the identification of this more mildly symptomatic patient group. However, the term ‘asymptomatic’ may be misleading as many patients identified through routine screening can have non-specific symptoms such as fatigue, depression and poor general health. Thus, physicians have been faced with several challenges in this disease in recent years, including the initial increase in numbers of patients with primary HPT and questions regarding the optimal management of individuals with asymptomatic/mildly symptomatic disease. To read full article please click here.