J Clin Outcomes Manage
Diagnosis and management of primary hyperparathyroidism
Cusano NE, Bilezikian JP
Abstract Objective: To review new developments in the diagnosis and management of primary hyperparathyroidism. Methods: Review of the literature. Results: Primary hyperparathyroidism is one of the most common endocrine disorders, especially among postmenopausal women. Patients with hypercalcemia can be diagnosed with primary hyperparathyroidism in the setting of elevated or inappropriately normal parathyroid hormone (PTH) levels. A newer presentation of primary hyperparathyroidism has been described, normocalcemic primary hyperparathyroidism, in which patients have normal total and ionized serum calcium concentrations and consistently elevated PTH levels, excluding secondary etiologies of hyperparathyroidism. Most patients with pri-mary hyperparathyroidism present asymptomatically, although decreased bone density at the distal 1/3 radius site is usually noted at the time of diagnosis. Conclusion: Patients with symptomatic primary hyperparathyroidism and those with asymptomatic disease who meet criteria for surgery should be advised to have surgical removal of the abnormal parathyroid gland(s). Those who do not meet criteria for surgery can be managed nonoperatively with surveillance by biochemical and densitometric measurements. Pharmacologic options are available for those who meet surgical criteria but either refuse surgery or are not deemed suitable for surgery.
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