Clinical Reviews in Bone and Mineral Metabolism

, Volume 1, Issue 1, pp 25-34

Primary hyperparathyroidism

Epidemiology and clinical consequences
  • John P. BilezikianAffiliated withDepartment of Medicine College of Physicians and Surgeons, Columbia University Email author 
  • , Shonni J. SilverbergAffiliated withDepartment of Medicine College of Physicians and Surgeons, Columbia University

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The earliest clinical descriptions of primary hyperparathyroidism pointed to an inexorably progressive disorder. Now, in asymptomatic individuals who do not meet any surgical guidelines, primary hyperparathyroidism, in general, does not appear to be progressive. Asymptomatic patients appear to remain asymptomatic over many years of observation. In those with major clinical manifestations, nephrolithiasis is, by far, the most common. In these patients, surgery is clearly indicated. Bone densitometry is an indispensable component of the evaluation as well as in monitoring in that there is evidence for bone involvement by this technology in most patients. This contrasts with the skeletal X-ray, which is invariably negative. Nevertheless, only the unusual patients will show a bone mass measurement that either at the cortical or cancellous skeleton that is more than two standard deviations below age-and sex-matched control subjects. Such individuals should, however, also be recommended for parathyroid surgery. Bone density, the serum calcium concentration, and/or urinary calcium excretion per se can show evidence for progression in as many as 25% with asymptomatic primary hyperparathyroidism. For this reason, all patients who are not going to have surgery for primary hyperparathyroidism should be monitored with biannual (serum calcium concentration) or annual testing (urinary calcium excretion and bone densitometry).