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Surgical Management of Asymptomatic Primary Hyperparathyroidism

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Handbook of Parathyroid Diseases

Abstract

Operative management of primary hyperparathyroidism began in 1925 when Felix Mendl performed the first successful parathyroidectomy for a patient with Von Recklinghousen Disease. This landmark operation initiated the practice of parathyroidectomy for patients with primary hyperparathyroidism and osteitis fibrosa cystica between 1925 and 1932. In 1932, Dr. Fuller Albright noted that 80% of patients treated with parathyroidectomy for primary hyperparathyroidism and osteitis fibrosa cystica also had either nephrolithiasis or nephrocalcinosis. This observation widened the criteria for operative intervention to include patients with hyperparathyroidism and nephrolithiasis and less severe bone disease. Thus, over the subsequent 30 years, the major indication for parathyroidectomy became renal stones without overt bone disease.

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References

  1. Sosa JA, Udelsman R. New directions in the treatment of patients with primary hyperparathyroidism. Curr Probl Surg. 2003;40(12):812–49.

    Article  PubMed  Google Scholar 

  2. AACE/AAES Task Force on Primary Hyperparathyroidism. The American Association of Clinical Endocrinologists and the American Association of Endocrine Surgeons position statement on the diagnosis and management of primary hyperparathyroidism. Endocr Pract. 2005;11(1):49–54.

    Google Scholar 

  3. Chan AK, Duh QY, Katz MH, et al. Clinical manifestations of primary hyperparathyroidism before and after parathyroidectomy. A case–control study. Ann Surg. 1995;222(3):402–12. discussion 412–4.

    Article  PubMed  CAS  Google Scholar 

  4. Christensson T, Hellstrom K, Wengle B, et al. Prevalence of hypercalcaemia in a health screening in Stockholm. Acta Med Scand. 1976;200(1–2):131–7.

    PubMed  CAS  Google Scholar 

  5. Diagnosis and management of asymptomatic primary hyperparathyroidism. National Institutes of Health Consensus Development Conference, October 29–31, 1990. Consens Statement 1990;8(7):1–18.

    Google Scholar 

  6. Clark OH, Duh QY. Primary hyperparathyroidism. A surgical perspective. Endocrinol Metab Clin North Am. 1989;18(3):701–14.

    PubMed  CAS  Google Scholar 

  7. Eigelberger MS, Cheah WK, Ituarte PH, et al. The NIH criteria for parathyroidectomy in asymptomatic primary hyperparathyroidism: are they too limited? Ann Surg. 2004;239(4): 528–35.

    Article  PubMed  Google Scholar 

  8. Boughey JC, Ewart CJ, Yost MJ, et al. Chloride/phosphate ratio in primary hyperparathyroidism. Am Surg. 2004;70(1):25–8.

    PubMed  CAS  Google Scholar 

  9. Bilezikian JP, Potts Jr JT, Fuleihan Gel H, et al. Summary statement from a workshop on asymptomatic primary hyperparathyroidism: a perspective for the 21st century. J Clin Endocrinol Metab. 2002;87(12):5353–61.

    Article  PubMed  CAS  Google Scholar 

  10. Bilezikian JP, Khan AA, Potts Jr JT. Guidelines for the management of asymptomatic primary hyperparathyroidism: summary statement from the third international workshop. J Clin Endocrinol Metab. 2009;94(2):335–9.

    Article  PubMed  CAS  Google Scholar 

  11. Udelsman R, Pasieka JL, Sturgeon C, et al. Surgery for asymptomatic primary hyperparathyroidism: proceedings of the third international workshop. J Clin Endocrinol Metab. 2009;94(2):366–72.

    Article  PubMed  CAS  Google Scholar 

  12. Silverberg SJ, Bilezikian JP. Evaluation and management of primary hyperparathyroidism. J Clin Endocrinol Metab. 1996;81(6):2036–40.

    Article  PubMed  CAS  Google Scholar 

  13. Mack LA, Pasieka JL. Asymptomatic primary hyperparathyroidism: a surgical perspective. Surg Clin North Am. 2004;84(3):803–16.

    Article  PubMed  Google Scholar 

  14. Ambrogini E, Cetani F, Cianferotti L, et al. Surgery or surveillance for mild asymptomatic primary hyperparathyroidism: a prospective, randomized clinical trial. J Clin Endocrinol Metab. 2007;92(8):3114–21.

    Article  PubMed  CAS  Google Scholar 

  15. Bollerslev J, Jansson S, Mollerup CL, et al. Medical observation, compared with parathyroidectomy, for asymptomatic primary hyperparathyroidism: a prospective, randomized trial. J Clin Endocrinol Metab. 2007;92(5):1687–92.

    Article  PubMed  CAS  Google Scholar 

  16. Clark OH. “Asymptomatic” primary hyperparathyroidism: is parathyroidectomy indicated? Surgery. 1994;116(6):947–53.

    PubMed  CAS  Google Scholar 

  17. Clark OH. Surgical treatment of primary hyperparathyroidism. Adv Endocrinol Metab. 1995;6:1–16.

    PubMed  CAS  Google Scholar 

  18. Clark OH. Current management of patients with hyperparathyroidism. Adv Surg. 1996;30:179–87.

    PubMed  CAS  Google Scholar 

  19. Clark OH. How should patients with primary hyperparathyroidism be treated? J Clin Endocrinol Metab. 2003;88(7):3011–4.

    Article  PubMed  Google Scholar 

  20. Clark OH, Wilkes W, Siperstein AE, Duh QY. Diagnosis and management of asymptomatic hyperparathyroidism: safety, efficacy, and deficiencies in our knowledge. J Bone Miner Res. 1991;6 Suppl 2:S135–42. discussion 151–2.

    PubMed  Google Scholar 

  21. Lafferty FW, Hubay CA. Primary hyperparathyroidism. A review of the long-term surgical and nonsurgical morbidities as a basis for a rational approach to treatment. Arch Intern Med. 1989;149(4):789–96.

    Article  PubMed  CAS  Google Scholar 

  22. Silverberg SJ, Shane E, Jacobs TP, et al. A 10-year prospective study of primary hyperparathyroidism with or without parathyroid surgery. N Engl J Med. 1999;341(17):1249–55.

    Article  PubMed  CAS  Google Scholar 

  23. Hasse C, Sitter H, Bachmann S, et al. How asymptomatic is asymptomatic primary hyperparathyroidism? Exp Clin Endocrinol Diabetes. 2000;108(4):265–74.

    Article  PubMed  CAS  Google Scholar 

  24. Uden P, Chan A, Duh QY, et al. Primary hyperparathyroidism in younger and older patients: symptoms and outcome of surgery. World J Surg. 1992;16(4):791–7. discussion 798.

    Article  PubMed  CAS  Google Scholar 

  25. Perrier ND, Coker LH, Rorie KD, et al. Preliminary report: functional MRI of the brain may be the ideal tool for evaluating neuropsychologic and sleep complaints of patients with primary hyperparathyroidism. World J Surg. 2006;30(5):686–96.

    Article  PubMed  Google Scholar 

  26. Talpos GB, Bone III HG, Kleerekoper M, et al. Randomized trial of parathyroidectomy in mild asymptomatic primary hyperparathyroidism: patient description and effects on the SF-36 health survey. Surgery. 2000;128(6):1013–20. discussion 1020–1.

    Article  PubMed  CAS  Google Scholar 

  27. Larsson K, Ljunghall S, Krusemo UB, et al. The risk of hip fractures in patients with primary hyperparathyroidism: a population-based cohort study with a follow-up of 19 years. J Intern Med. 1993;234(6):585–93.

    Article  PubMed  CAS  Google Scholar 

  28. Peacock M, Bilezikian JP, Klassen PS, et al. Cinacalcet hydrochloride maintains long-term normocalcemia in patients with primary hyperparathyroidism. J Clin Endocrinol Metab. 2005;90(1):135–41.

    Article  PubMed  CAS  Google Scholar 

  29. Silverberg SJ, Lewiecki EM, Mosekilde L, et al. Presentation of asymptomatic primary hyperparathyroidism: proceedings of the third international workshop. J Clin Endocrinol Metab. 2009;94(2):351–65.

    Article  PubMed  CAS  Google Scholar 

  30. Nomura R, Sugimoto T, Tsukamoto T, et al. Marked and sustained increase in bone mineral density after parathyroidectomy in patients with primary hyperparathyroidism; a six-year longitudinal study with or without parathyroidectomy in a Japanese population. Clin Endocrinol (Oxf). 2004;60(3):335–42.

    Article  Google Scholar 

  31. Vestergaard P, Mollerup CL, Frokjaer VG, et al. Cohort study of risk of fracture before and after surgery for primary hyperparathyroidism. BMJ. 2000;321(7261):598–602.

    Article  PubMed  CAS  Google Scholar 

  32. Siilin H, Rastad J, Ljunggren O, Lundgren E. Disturbances of calcium homeostasis consistent with mild primary hyperparathyroidism in premenopausal women and associated morbidity. J Clin Endocrinol Metab. 2008;93(1):47–53.

    Article  PubMed  CAS  Google Scholar 

  33. Chow CC, Chan WB, Li JK, et al. Oral alendronate increases bone mineral density in postmenopausal women with primary hyperparathyroidism. J Clin Endocrinol Metab. 2003;88(2): 581–7.

    Article  PubMed  CAS  Google Scholar 

  34. Khan AA, Bilezikian JP, Kung AW, et al. Alendronate in primary hyperparathyroidism: a double-blind, randomized, placebo-controlled trial. J Clin Endocrinol Metab. 2004;89(7): 3319–25.

    Article  PubMed  CAS  Google Scholar 

  35. Nikkila MT, Saaristo JJ, Koivula TA. Clinical and biochemical features in primary hyperparathyroidism. Surgery. 1989;105(2 Pt 1):148–53.

    PubMed  CAS  Google Scholar 

  36. Yang AH, Hsu CW, Chen JY, et al. Normocalcemic primary hyperparathyroidism in patients with recurrent kidney stones: pathological analysis of parathyroid glands. Virchows Arch. 2006;449(1):62–8.

    Article  PubMed  Google Scholar 

  37. Mitlak BH, Daly M, Potts Jr JT, et al. Asymptomatic primary hyperparathyroidism. J Bone Miner Res. 1991;6 Suppl 2:S103–10. discussion S121–4.

    PubMed  Google Scholar 

  38. Deaconson TF, Wilson SD, Lemann Jr J. The effect of parathyroidectomy on the recurrence of nephrolithiasis. Surgery. 1987;102(6):910–3.

    PubMed  CAS  Google Scholar 

  39. Edvall CA. Renal function in hyperparathyroidism; a clinical study of 30 cases with special reference to selective renal clearance and renal vein catheterization. Acta Chir Scand Suppl. 1958;114 Suppl 229:1–56.

    PubMed  CAS  Google Scholar 

  40. Hedback G, Abrahamsson K, Oden A. The improvement of renal concentration capacity after surgery for primary hyperparathyroidism. Eur J Clin Invest. 2001;31(12):1048–53.

    Article  PubMed  CAS  Google Scholar 

  41. Chou FF, Sheen-Chen SM, Leong CP. Neuromuscular recovery after parathyroidectomy in primary hyperparathyroidism. Surgery. 1995;117(1):18–25.

    Article  PubMed  CAS  Google Scholar 

  42. Joborn C, Rastad J, Stalberg E, et al. Muscle function in patients with primary hyperparathyroidism. Muscle Nerve. 1989;12(2):87–94.

    Article  PubMed  CAS  Google Scholar 

  43. Patten BM, Bilezikian JP, Mallette LE, et al. Neuromuscular disease in primary hyperparathyroidism. Ann Intern Med. 1974;80(2):182–93.

    PubMed  CAS  Google Scholar 

  44. Joborn C, Hetta J, Niklasson F, et al. Cerebrospinal fluid calcium, parathyroid hormone, and monoamine and purine metabolites and the blood–brain barrier function in primary hyperparathyroidism. Psychoneuroendocrinology. 1991;16(4):311–22.

    Article  PubMed  CAS  Google Scholar 

  45. Palmer M, Adami HO, Bergstrom R, et al. Survival and renal function in untreated hypercalcaemia. Population-based cohort study with 14 years of follow-up. Lancet. 1987;1(8524): 59–62.

    Article  PubMed  CAS  Google Scholar 

  46. Hedback G, Oden A. Increased risk of death from primary hyperparathyroidism–an update. Eur J Clin Invest. 1998;28(4):271–6.

    Article  PubMed  CAS  Google Scholar 

  47. Piovesan A, Molineri N, Casasso F, et al. Left ventricular hypertrophy in primary hyperparathyroidism. Effects of successful parathyroidectomy. Clin Endocrinol (Oxf). 1999;50(3): 321–8.

    Article  CAS  Google Scholar 

  48. Hellstrom J, Birke G, Edvall CA. Hypertension in hyperparathyroidism. Br J Urol. 1958;30(1): 13–24.

    Article  PubMed  CAS  Google Scholar 

  49. Heath III H. Clinical spectrum of primary hyperparathyroidism: evolution with changes in medical practice and technology. J Bone Miner Res. 1991;6 Suppl 2:S63–70. discussion S83–4.

    PubMed  Google Scholar 

  50. Ringe JD. Reversible hypertension in primary hyperparathyroidism–pre- and posteroperative blood pressure in 75 cases. Klin Wochenschr. 1984;62(10):465–9.

    Article  PubMed  CAS  Google Scholar 

  51. Diamond TW, Botha JR, Wing J, et al. Parathyroid hypertension. A reversible disorder. Arch Intern Med. 1986;146(9):1709–12.

    Article  PubMed  CAS  Google Scholar 

  52. Havlik RJ, LaCroix AZ, Kleinman JC, et al. Antihypertensive drug therapy and survival by treatment status in a national survey. Hypertension. 1989;13(5 Suppl):I28–32.

    PubMed  CAS  Google Scholar 

  53. Hedback GM, Oden AS. Cardiovascular disease, hypertension and renal function in primary hyperparathyroidism. J Intern Med. 2002;251(6):476–83.

    Article  PubMed  CAS  Google Scholar 

  54. Stefenelli T, Abela C, Frank H, et al. Cardiac abnormalities in patients with primary hyperparathyroidism: implications for follow-up. J Clin Endocrinol Metab. 1997;82(1):106–12.

    Article  PubMed  CAS  Google Scholar 

  55. Vestergaard P, Mollerup CL, Frokjaer VG, et al. Cardiovascular events before and after surgery for primary hyperparathyroidism. World J Surg. 2003;27(2):216–22.

    PubMed  Google Scholar 

  56. Christensson T, Einarsson K. Serum lipids before and after parathyroidectomy in patients with primary hyperparathyroidism. Clin Chim Acta. 1977;78(3):411–5.

    Article  PubMed  CAS  Google Scholar 

  57. Ljunghall S, Lithell H, Vessby B, Wide L. Glucose and lipoprotein metabolism in primary hyperparathyroidism. Effects of parathyroidectomy. Acta Endocrinol (Copenh). 1978;89(3): 580–9.

    CAS  Google Scholar 

  58. Lacour B, Roullet JB, Liagre AM, et al. Serum lipoprotein disturbances in primary and secondary hyperparathyroidism and effects of parathyroidectomy. Am J Kidney Dis. 1986;8(6):422–9.

    PubMed  CAS  Google Scholar 

  59. Cheung PS, Thompson NW, Brothers TE, Vinik AI. Effect of hyperparathyroidism on the control of diabetes mellitus. Surgery. 1986;100(6):1039–47.

    PubMed  CAS  Google Scholar 

  60. Ljunghall S, Palmer M, Akerstrom G, Wide L. Diabetes mellitus, glucose tolerance and insulin response to glucose in patients with primary hyperparathyroidism before and after parathyroidectomy. Eur J Clin Invest. 1983;13(5):373–7.

    Article  PubMed  CAS  Google Scholar 

  61. Valdemarsson S, Lindblom P, Bergenfelz A. Metabolic abnormalities related to cardiovascular risk in primary hyperparathyroidism: effects of surgical treatment. J Intern Med. 1998;244(3): 241–9.

    Article  PubMed  CAS  Google Scholar 

  62. Kumar S, Olukoga AO, Gordon C, et al. Impaired glucose tolerance and insulin insensitivity in primary hyperparathyroidism. Clin Endocrinol (Oxf). 1994;40(1):47–53.

    Article  CAS  Google Scholar 

  63. Richards ML, Thompson NW. Diabetes mellitus with hyperparathyroidism: another indication for parathyroidectomy? Surgery. 1999;126(6):1160–6.

    Article  PubMed  CAS  Google Scholar 

  64. Fadda GZ, Akmal M, Lipson LG, Massry SG. Direct effect of parathyroid hormone on insulin secretion from pancreatic islets. Am J Physiol. 1990;258(6 Pt 1):E975–84.

    PubMed  CAS  Google Scholar 

  65. Prager R, Schernthaner G, Niederle B, Roka R. Evaluation of glucose tolerance, insulin secretion, and insulin action in patients with primary hyperparathyroidism before and after surgery. Calcif Tissue Int. 1990;46(1):1–4.

    Article  PubMed  CAS  Google Scholar 

  66. Cogan MG, Covey CM, Arieff AI, et al. Central nervous system manifestations of hyperparathyroidism. Am J Med. 1978;65(6):963–70.

    Article  PubMed  CAS  Google Scholar 

  67. Joborn C, Hetta J, Johansson H, et al. Psychiatric morbidity in primary hyperparathyroidism. World J Surg. 1988;12(4):476–81.

    Article  PubMed  CAS  Google Scholar 

  68. Joborn C, Hetta J, Lind L, et al. Self-rated psychiatric symptoms in patients operated on because of primary hyperparathyroidism and in patients with long-standing mild hypercalcemia. Surgery. 1989;105(1):72–8.

    PubMed  CAS  Google Scholar 

  69. Karpati G, Frame B. Neuropsychiatric disorders in primary hyperparathyroidism. Clinical analysis with review of the literature. Arch Neurol. 1964;10:387–97.

    Article  PubMed  CAS  Google Scholar 

  70. Mallette LE, Bilezikian JP, Heath DA, Aurbach GD. Primary hyperparathyroidism: clinical and biochemical features. Medicine (Baltimore). 1974;53(2):127–46.

    CAS  Google Scholar 

  71. Joborn C, Hetta J, Rastad J, et al. Psychiatric symptoms and cerebrospinal fluid monoamine metabolites in primary hyperparathyroidism. Biol Psychiatry. 1988;23(2):149–58.

    Article  PubMed  CAS  Google Scholar 

  72. Dubovsky SL, Franks RD. Intracellular calcium ions in affective disorders: a review and an hypothesis. Biol Psychiatry. 1983;18(7):781–97.

    PubMed  CAS  Google Scholar 

  73. Burney RE, Jones KR, Peterson M, et al. Surgical correction of primary hyperparathyroidism improves quality of life. Surgery. 1998;124(6):987–91. discussion 991–2.

    Article  PubMed  CAS  Google Scholar 

  74. Solomon BL, Schaaf M, Smallridge RC. Psychologic symptoms before and after parathyroid surgery. Am J Med. 1994;96(2):101–6.

    Article  PubMed  CAS  Google Scholar 

  75. Sivula A, Ronni-Sivula H. The changing picture of primary hyperparathyroidism in the years 1956–1979. Ann Chir Gynaecol. 1984;73(6):319–24.

    PubMed  CAS  Google Scholar 

  76. Okamoto T, Gerstein HC, Obara T. Psychiatric symptoms, bone density and non-specific symptoms in patients with mild hypercalcemia due to primary hyperparathyroidism: a systematic overview of the literature. Endocr J. 1997;44(3):367–74.

    Article  PubMed  CAS  Google Scholar 

  77. Pasieka JL, Parsons LL, Demeure MJ, et al. Patient-based surgical outcome tool demonstrating alleviation of symptoms following parathyroidectomy in patients with primary hyperparathyroidism. World J Surg. 2002;26(8):942–9.

    Article  PubMed  Google Scholar 

  78. Pasieka JL, Parsons LL. Prospective surgical outcome study of relief of symptoms following surgery in patients with primary hyperparathyroidism. World J Surg. 1998;22(6):513–8. discussion 518–9.

    Article  PubMed  CAS  Google Scholar 

  79. Pasieka JL, Parsons LL. A prospective surgical outcome study assessing the impact of parathyroidectomy on symptoms in patients with secondary and tertiary hyperparathyroidism. Surgery. 2000;128(4):531–9.

    Article  PubMed  CAS  Google Scholar 

  80. Rao DS, Phillips ER, Divine GW, Talpos GB. Randomized controlled clinical trial of surgery versus no surgery in patients with mild asymptomatic primary hyperparathyroidism. J Clin Endocrinol Metab. 2004;89(11):5415–22.

    Article  PubMed  CAS  Google Scholar 

  81. Hedback G, Oden A. Survival of patients operated on for primary hyperparathyroidism. Surgery. 1999;125(2):240–1.

    Article  PubMed  CAS  Google Scholar 

  82. Posen S, Clifton-Bligh P, Reeve TS, et al. Is parathyroidectomy of benefit in primary hyperparathyroidism? Q J Med. 1985;54(215):241–51.

    PubMed  CAS  Google Scholar 

  83. Palmer M, Ljunghall S, Akerstrom G, et al. Patients with primary hyperparathyroidism operated on over a 24-year period: temporal trends of clinical and laboratory findings. J Chronic Dis. 1987;40(2):121–30.

    Article  PubMed  CAS  Google Scholar 

  84. Hedback G, Tisell LE, Bengtsson BA, et al. Premature death in patients operated on for primary hyperparathyroidism. World J Surg. 1990;14(6):829–35. discussion 836.

    Article  PubMed  CAS  Google Scholar 

  85. Hedback G, Oden A, Tisell LE. The influence of surgery on the risk of death in patients with primary hyperparathyroidism. World J Surg. 1991;15(3):399–405. discussion 406–7.

    Article  PubMed  CAS  Google Scholar 

  86. Nilsson IL, Wadsten C, Brandt L, et al. Mortality in sporadic primary hyperparathyroidism: nationwide cohort study of multiple parathyroid gland disease. Surgery. 2004;136(5):981–7.

    Article  PubMed  Google Scholar 

  87. Hedback G, Oden A. Death risk factor analysis in primary hyperparathyroidism. Eur J Clin Invest. 1998;28(12):1011–8.

    Article  PubMed  CAS  Google Scholar 

  88. Scholz DA, Purnell DC. Asymptomatic primary hyperparathyroidism. 10-year prospective study. Mayo Clin Proc. 1981;56(8):473–8.

    PubMed  CAS  Google Scholar 

  89. Purnell DC, Smith LH, Scholz DA, et al. Primary hyperparathyroidism: a prospective clinical study. Am J Med. 1971;50(5):670–8.

    Article  PubMed  CAS  Google Scholar 

  90. Kebebew E, Hwang J, Reiff E, et al. Predictors of single-gland vs. multigland parathyroid disease in primary hyperparathyroidism: a simple and accurate scoring model. Arch Surg. 2006;141(8):777–82. discussion 782.

    Article  PubMed  Google Scholar 

  91. Clark OH, Duh Q-Y, Kebebew E. Textbook of endocrine surgery. 2nd ed. Philadelphia: W.B. Saunders; 2005.

    Google Scholar 

  92. Zanocco K, Angelos P, Sturgeon C. Cost-effectiveness analysis of parathyroidectomy for asymptomatic primary hyperparathyroidism. Surgery. 2006;140(6):874–81. discussion 881–2.

    Article  PubMed  Google Scholar 

  93. Sejean K, Calmus S, Durand-Zaleski I, et al. Surgery versus medical follow-up in patients with asymptomatic primary hyperparathyroidism: a decision analysis. Eur J Endocrinol. 2005; 153(6):915–27.

    Article  PubMed  CAS  Google Scholar 

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Farkas, R., Moalem, J., Clark, O.H. (2012). Surgical Management of Asymptomatic Primary Hyperparathyroidism. In: Khan, MD, A., Clark, O. (eds) Handbook of Parathyroid Diseases. Springer, Boston, MA. https://doi.org/10.1007/978-1-4614-2164-1_7

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