Abstract
Although surgery is unambiguously recommended for symptomatic primary hyperparathyroidism (PHPT) patients, management options for asymptomatic patients have varied between surgery, medications and follow-up. To deal with this issue, four International Workshops have taken place, in 1990, 2002, 2008 and 2014, during which a team of experts drew up criteria to stratify asymptomatic patients as surgery-eligible and surgery-ineligible. The efficacy of the criteria have however been questioned over the years and the majority of patients, both eligible and ineligible, may eventually have undergone surgery. Nevertheless, the criteria are still in use today and they clearly mirror the course of change in the treatment of PHPT patients.
Article PDF
Similar content being viewed by others
Avoid common mistakes on your manuscript.
References
Adami S, Marcocci C, Gatti D, 2002 Epidemiology of primary hyperparathyroidism in Europe. J Bone Miner Res 17: Suppl 2: N18–23.
AACE/AAES Task Force on Primary Hyperparathyroidism 2005 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 11: 49–54.
Elaraj DM, Clark OH, 2008 Current Status and Treatment of Primary Hyperparathyroidism. Perm J 12: 32–37.
Chan AK, Duh QY, Katz MH, Siperstein AE, Clark OH, 1995 Clinical manifestations of primary hyperparathyroidism before and after parathyroidectomy. A case-control study. Ann Surg 222: 402–412.
1990 Diagnosis and Management of Asymptomatic Primary Hyperparathyroidism. NIH Consensus Development Conference Statement 8: 1–18.
Sheldon DG, Lee FT, Neil NJ, Ryan JA Jr, 2002 Surgical treatment of hyperparathyroidism improves health-related quality of life. Arch Surg 137: 1022–1028.
Weber T, Keller M, Hense I, et al, 2007 Effect of parathyroidectomy on quality of life and neuropsychological symptoms in primary hyperparathyroidism. World J Surg 31: 1202–1209.
Mihai R, Sadler GP, 2008 Pasieka’s parathyroid symptoms scores correlate with SF-36 scores in patients undergoing surgery for primary hyperparathyroidism. World J Surg 32: 807–814.
Ramakant P, Verma AK, Chand G, et al, 2011 Salutary effect of parathyroidectomy on neuropsychiatric symptoms in patients with primary hyperparathyroidism: evaluation using PAS and SF-36v2 scoring systems. J Postgrad Med 57: 96–101.
Potts JT Jr., Juppner H 2012 Disorders of the Parathyroid Gland and Calcium Homeostasi. In: Harrison’s Principles of Internal Medicine, 18th Edition, McGraw-Hill; Chapter 353: 3096–3120.
Bilezikian JP, Potts JT Jr., Fuleihan Gel-H, et al, 2002 Summary Statement from a Workshop on Asymptomatic Primary Hyperparathyroidism: a Perspective for the 21st Century. J Bone Miner Res 17: Suppl 2: N2–11.
Silverberg SJ, Locker FG, Bilezikian JP, 1996 Vertebral osteopenia: a new indication for surgery in primary hyperparathyroidism. J Clin Endocrinol Metab 81: 4007–4012.
Abugassa S, Nordenström J, Eriksson S, Möllerström G, Alveryd A, 1990 Skeletal remineralization after surgery for primary and secondary hyperparathyroidism. Surgery 107: 128–133.
Silverberg SJ, Brown I, Bilezikian JP, 2002 Age as a criterion for surgery in primary hyperparathyroidism. Am J Med 113: 681–684.
Norman J, Lopez J, Politz D, 2011 Abandoning unilateral parathyroidectomy: why we reversed our position after 15,000 parathyroid operations. J Am Coll Surg 214: 260–269.
Norman J, 2012 Controversies in parathyroid surgery: The quest for a “mini” unilateral parathyroid operation seems to have gonetoo far. J Surg Oncol 105: 1–3.
Brunaud L, Zarnegar R, Wada N, Ituarte P, Clark OH, Duh QY, 2003 Incision length for standard thyroidectomy and parathyroidectomy: when is it minimally invasive? Arch Surg 138: 1140–1143.
Eigelberger MS W, Keat Cheah, Ituarte PHG, Streja L, Duh Q-Y, Clark OH, 2004 The NIH Criteria for Parathyroidectomy in Asymptomatic Primary Hyperparathyroidism: Are They Too Limited? Ann Surg 239: 528–535.
Silverberg SJ, Shane E, Jacobs TP, et al, 1999 A 10-year prospective study of primary hyperparathyroidism with or without parathyroid surgery. N Engl J Med 341: 1249–1255.
Scholz DA, Purnell DC, 1981 Asymptomatic primary hyperparathyroidism. 10-year prospective study. Mayo Clin Proc 56: 473–478.
Rubin MR, Bilezikian JP, McMahon DJ, et al, 2008 The natural history of primary hyperparathyroidism with or without parathyroid surgery after 15 years. J Clin Endocrinol Metab 93: 3462–3470.
Silverberg SJ, Lewiecki EM, Mosekilde L, et al, 2009 Presentation of asymptomatic primary hyperparathyroidism: proceedings of the Third International Workshop. J Clin Endocrinol Metab 94:351–365.
Bilezikian JP, Khan AA, Potts JT Jr, 2009 Guidelines for the management of asymptomatic primary hyperparathyroidism: summary statement from the third international workshop. J Clin Endocrinol Metab 94: 335–339.
Stavrakis AI, Ituarte PH, Ko CY, Yeh MW, 2007 Surgeon volume as a predictor of outcomes in inpatient and outpatient endocrine surgery. Surgery 142: 887–899.
Sosa JA, Powe NR, Levine MA, et al, 1998 Profile of a clinical practice: Thresholds for surgery and surgical outcomes for patients with primary hyperparathyroidism: a national survey of endocrine surgeons. J Clin Endocrinol Metab 83: 2658–2665.
Udelsman R, Pasieka JL, Sturgeon C, Young JEM, Clark OH, 2009 Surgery for asymptomatic primary hyperparathyroidism: proceedings of the Third International Workshop. J Clin Endocrinol Metab 94: 366–372.
Westerdahl J, Bergenfelz A, 2007 Unilateral versus bilateral neck explorat ion for primary hyperparathyroidism: five-year follow-up of a randomized controlled trial. Ann Surg 246: 976–981.
Russell CF, Dolan SJ, Laird JD, 2006 Randomized clinical trial comparing scan-directed unilateral versus bilateral cervical exploration for primary hyperparathyroidism due to solitary adenoma. Br J Surg 4: 418–421.
Rio PD, Vicente D, Maestroni U, et al, 2013 A comparison of minimally invasive video-assisted parathyroidectomy and traditional parathyroidectomy for parathyroid adenoma. J Cancer 4: 458–463.
Schneider DF, Mazeh H, Sippel RS, Chen H, 2012 Is minimally invasive parathyroidectomy associated with greater recurrence compared to bilateral exploration? Analysis of more than 1,000 cases. Surgery 152: 1008–1015.
Norman J, Politz D, 2009 5,000 parathyroid operations without frozen section or PTH assays: measuring individual parathyroid glandhormone production in real time. Ann Surg Oncol 16: 656–666.
Kunstman JW, Udelsman R, 2012 Superiority of minimally invasive parathyroidectomy. Adv Surg 46: 171–189.
Udelsman R, Lin Z, Donovan P, 2011 The superiority of minimally invasive parathyroidectomy based on 1650 consecutive patients with primary hyperparathyroidism. Ann Surg 253: 585–591.
Yeh MW, Wiseman JE, Ituarte PH, et al, 2012 Surgery for primary hyperparathyroidism: are the consensus guidelines being followed? Ann Surg 255: 1179–1183.
Khan A, Grey A, Shoback D, 2009 Medical management of asymptomatic primary hyperparathyroidism: proceedings of the Third International Workshop. J Clin Endocrinol Metab 94: 373–381.
Holick MF, Binkley NC, Bischoff-Ferrari HA, et al, 2011 Evaluation, treatment, and prevention of vitamin D deficiency: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab; 96: 1911–1930.
Vierucci F, Del Pistoia M, Fanos M, Erba P, Saggese G, 2014 Prevalence of hypovitaminosis D and predictors of vitamin D status in Italian healthy adolescents. Ital J Pediatr 40: 54.
Hoteit M, Al-Shaar L, Yazbeck C, Bou Sleiman M, Ghalayini T, Fuleihan Gel-H, 2014 Hypovitaminosis D in a sunny country: time trends, predictors, and implications for practice guidelines. Metabolism 63: 968–978.
Souberbielle JC, Cormier C, Kindermans C, et al, 2001 Vitamin D status and redefining serum parathyroid hormone reference range in the elderly. J Clin Endocrinol Metab 86: 3086–3090.
Fillée C, Keller T, Mourad M, Brinkmann T, Ketelslegers JM, 2012 Impact of vitamin D-related serum PTH reference values on the diagnosis of mild primary hyperparathyroidism, using bivariate calcium/PTH reference regions. Clin Endocrinol (Oxf) 76: 785–789.
Grey A, Lucas J, Home A, Gamble G, Davidson JS, Reid IR, 2005 Vitamin D repletion in patients with primary hyperparathyroidism and coexistent vitamin D insufficiency. J Clin Endocrinol Metab 90: 2122–2126.
Bollerslev J, Marcocci C, Sosa M, Nordenström J, Bouillon R, Mosekilde L, 2011 Current evidence for recommendation of surgery, medical treatment and vitamin D repletion in mild primary hyperparathyroidism. Eur J Endocrinol 165: 851–864.
Farahnak P, Lärfars G, Sten-Linder M, Nilsson IL, 2011 Mild primary hyperparathyroidism: vitamin D deficiency and cardiovascular risk markers. J Clin Endocrinol Metab 96: 2112–2118.
Clements MR, Davies M, Fraser DR, Lumb GA, Mawer EB, Adams PH, 1987 Metabolic inactivation of vitamin D is enhanced in primary hyperparathyroidism. Clin Sci (Lond) 736: 659–664.
Kawahara M, Iwasaki Y, Sakaguchi K, et al, 2008 Predominant role of 25OHD in the negative regulation of PTH expression: clinical relevance for hypovitaminosis D. Life Sci 82: 677–683.
Silverberg SJ, Clarke BL, Peacock M, et al, 2014 Current issues in the presentation of asymptomatic primary hyperparathyroidism: proceedings of the Fourth International Workshop. J Clin Endocrinol Metab 99: 3580–3594.
Wood K, Dhital S, Herbert C, Sippel R, 2012 What is the utility of distal forearm DXA in primary hyperparathyroidism? Oncologist 17: 322–325.
Udelsman R, Åkerström G, Biagini C, et al, 2014 The surgical management of asymptomatic primary hyperparathyroidism: proceedings of the Fourth International Workshop. J Clin Endocrinol Metab 99: 3595–3606.
Bilezikian JP, Brandi ML, Eastell R, et al, 2014 Guidelines for the management of asymptomatic primary hyperparathyroidism: summary statement from the Fourth International Workshop. J Clin Endocrinol Metab 99: 3561–3569.
Marcocci C, Bollerslev J, Khan AA, Shoback DM, 2014 Medical management of primary hyperparathyroidism: proceedings of the fourth International Workshop on the Management of Asymptomatic Primary Hyperparathyroidism. J Clin Endocrinol Metab 99: 3607–3618.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Sklavenitis-Pistofidis, R., Papaioannou, O. & Kotsa, K. Primary hyperparathyroidism and the road to surgery: appraisal of the proceedings of the four international workshops (1990, 2002, 2008, 2014) on primary hyperparathyroidism. Hormones 14, 201–210 (2015). https://doi.org/10.14310/horm.2002.1581
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.14310/horm.2002.1581