Primary Hyperparathyroidism

  • Kaitlyn J. Kelly
  • Herbert Chen
  • Rebecca S. Sippel
Part of the Cancer Treatment and Research book series (CTAR, volume 153)


This chapter describes the diagnosis, clinical features, and principles of management of primary hyperparathyroidism. The chapter focuses primarily on current management recommendations for patients with primary hyperparathyroidism, particularly for those with “asymptomatic” or mild disease. We also discuss the risks and benefits of parathyroidectomy for hyperparathyroidism and the various preoperative and intraoperative localization techniques currently in use to enable minimally invasive surgery. Lastly, we discuss the outcomes of medical and surgical therapy for this disease and the slightly different risk/benefit profile of parathyroidectomy in the reoperative setting.


Bone Mineral Density Parathyroid Gland Parathyroid Adenoma Serum Calcium Level Parathyroid Carcinoma 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. 1.
    Surgery of the Thyroid and Parathyroid Glands: Springer; 2007.Google Scholar
  2. 2.
    Carneiro-Pla DM, Irvin GL III, Chen H (2007) Consequences of parathyroidectomy in patients with “mild” sporadic primary hyperparathyroidism. Surgery 142(6):795–799; discussion 9 e1–e2Google Scholar
  3. 3.
    Ogard CG, Engholm G, Almdal TP, Vestergaard H (2004) Increased mortality in patients hospitalized with primary hyperparathyroidism during the period 1977–1993 in Denmark. World J Surg 28(1):108–111CrossRefPubMedGoogle Scholar
  4. 4.
    Hedback G, Oden A (1998) Increased risk of death from primary hyperparathyroidism – an update. Eur J Clin Invest 28(4):271–276CrossRefPubMedGoogle Scholar
  5. 5.
    Sambrook PN, Chen JS, March LM et al (2004) Serum parathyroid hormone is associated with increased mortality independent of 25-hydroxy vitamin d status, bone mass, and renal function in the frail and very old: a cohort study. J Clin Endocrinol Metab 89(11):5477–5481CrossRefPubMedGoogle Scholar
  6. 6.
    Palmér M, Adami HO, Bergstrom R, Akerstrom G, Ljunghall S (1987) Mortality after surgery for primary hyperparathyroidism: a follow-up of 441 patients operated on from 1956 to 1979. Surgery 102(1):1–7PubMedGoogle Scholar
  7. 7.
    Wermers RA, Khosla S, Atkinson EJ et al (1998) Survival after the diagnosis of hyperparathyroidism: a population-based study. Am J Med 104(2):115–122CrossRefPubMedGoogle Scholar
  8. 8.
    Palazzo FF, Delbridge LW (2004) Minimal-access/minimally invasive parathyroidectomy for primary hyperparathyroidism. Surg Clin North Am 84(3):717–734CrossRefPubMedGoogle Scholar
  9. 9.
    Siperstein A, Berber E, Barbosa GF et al (2008) Predicting the success of limited exploration for primary hyperparathyroidism using ultrasound, sestamibi, and intraoperative parathyroid hormone: analysis of 1158 cases. Ann Surg 248(3):420–428PubMedGoogle Scholar
  10. 10.
    Chen H, Mack E, Starling JR (2005) A comprehensive evaluation of perioperative adjuncts during minimally invasive parathyroidectomy: which is most reliable? Ann Surg 242(3):375–380; discussion 80–83Google Scholar
  11. 11.
    Moure D, Larranaga E, Dominguez-Gadea L et al (2008) 99MTc-sestamibi as sole technique in selection of primary hyperparathyroidism patients for unilateral neck exploration. Surgery 144(3):454–459CrossRefPubMedGoogle Scholar
  12. 12.
    Chen H (2004) Radioguided parathyroid surgery. Adv Surg 38:377–392PubMedGoogle Scholar
  13. 13.
    Chen H, Mack E, Starling JR (2003) Radioguided parathyroidectomy is equally effective for both adenomatous and hyperplastic glands. Ann Surg 238(3):332–337; discussion 7–8Google Scholar
  14. 14.
    Sippel RS, Bianco J, Chen H (2003) Radioguided parathyroidectomy for recurrent hyperparathyroidism caused by forearm graft hyperplasia. J Bone Miner Res 18(5):939–942CrossRefPubMedGoogle Scholar
  15. 15.
    Lew JI, Solorzano CC, Montano RE, Carneiro-Pla DM, Irvin GL III (2008) Role of intraoperative parathormone monitoring during parathyroidectomy in patients with discordant localization studies. Surgery 144(2):299–306CrossRefPubMedGoogle Scholar
  16. 16.
    Ito F, Sippel R, Lederman J, Chen H (2007) The utility of intraoperative bilateral internal jugular venous sampling with rapid parathyroid hormone testing. Ann Surg 245(6):959–963CrossRefPubMedGoogle Scholar
  17. 17.
    The American Association of Clinical Endocrinologists and the American Association of Endocrine Surgeons (2005) Position statement on the diagnosis and management of primary hyperparathyroidism. Endocr Pract 11(1):49–54Google Scholar
  18. 18.
    Silverberg SJ, Shane E, Jacobs TP, Siris E, Bilezikian JP (1999) A 10-year prospective study of primary hyperparathyroidism with or without parathyroid surgery. N Engl J Med 341(17):1249–1255CrossRefPubMedGoogle Scholar
  19. 19.
    Silverberg SJ, Brown I, Bilezikian JP (2002) Age as a criterion for surgery in primary hyperparathyroidism. Am J Med 113(8):681–684CrossRefPubMedGoogle Scholar
  20. 20.
    Clark OH, Wilkes W, Siperstein AE, Duh QY (1991) Diagnosis and management of asymptomatic hyperparathyroidism: safety, efficacy, and deficiencies in our knowledge. J Bone Miner Res 6 Suppl 2:S135–S142; discussion 51–52Google Scholar
  21. 21.
    Talpos GB, Bone HG III, Kleerekoper M, et al (2000) Randomized trial of parathyroidectomy in mild asymptomatic primary hyperparathyroidism: patient description and effects on the SF-36 health survey. Surgery 128(6):1013–1020;discussion 20–21Google Scholar
  22. 22.
    Rao DS (2001) Parathyroidectomy for asymptomatic primary hyperparathyroidism (PHPT): is it worth the risk? J Endocrinol Invest 24(2):131–134PubMedGoogle Scholar
  23. 23.
    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(2):335–339CrossRefPubMedGoogle Scholar
  24. 24.
    Udelsman R, Pasieka JL, Sturgeon C, Young JE, Clark OH (2009) Surgery for asymptomatic primary hyperparathyroidism: proceedings of the third international workshop. J Clin Endocrinol Metab 94(2):366–372CrossRefPubMedGoogle Scholar
  25. 25.
    Zanocco K, Angelos P, Sturgeon C (2006) Cost-effectiveness analysis of parathyroidectomy for asymptomatic primary hyperparathyroidism. Surgery 140(6):874–881; discussion 81–82Google Scholar
  26. 26.
    Zanocco K, Sturgeon C (2008) How should age at diagnosis impact treatment strategy in asymptomatic primary hyperparathyroidism? A cost-effectiveness analysis. Surgery 144(2):290–298CrossRefPubMedGoogle Scholar
  27. 27.
    Piovesan A, Molineri N, Casasso F, et al (1999) Left ventricular hypertrophy in primary hyperparathyroidism. Effects of successful parathyroidectomy. Clin Endocrinol (Oxf) 50(3):321–328Google Scholar
  28. 28.
    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 Clin Endocrinol Metab 87(12):5353–5361CrossRefPubMedGoogle Scholar
  29. 29.
    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(9):3462–3470CrossRefPubMedGoogle Scholar
  30. 30.
    Boucher A, D’Amour P, Hamel L et al (1989) Estrogen replacement decreases the set point of parathyroid hormone stimulation by calcium in normal postmenopausal women. J Clin Endocrinol Metab 68(4):831–836CrossRefPubMedGoogle Scholar
  31. 31.
    Selby PL, Peacock M (1986) Ethinyl estradiol and norethindrone in the treatment of primary hyperparathyroidism in postmenopausal women. N Engl J Med 314(23):1481–1485CrossRefPubMedGoogle Scholar
  32. 32.
    Rubin MR, Lee KH, McMahon DJ, Silverberg SJ (2003) Raloxifene lowers serum calcium and markers of bone turnover in postmenopausal women with primary hyperparathyroidism. J Clin Endocrinol Metab 88(3):1174–1178CrossRefPubMedGoogle Scholar
  33. 33.
    Fang WL, Tseng LM, Chen JY, et al (2008) The management of high-risk patients with primary hyperparathyroidism – minimally invasive parathyroidectomy vs. medical treatment. Clin Endocrinol (Oxf) 68(4):520–528Google Scholar
  34. 34.
    Tanvetyanon T, Stiff PJ (2006) Management of the adverse effects associated with intravenous bisphosphonates. Ann Oncol 17(6):897–907CrossRefPubMedGoogle Scholar
  35. 35.
    Wong P, Carmeci C, Jeffrey RB, Weigel RJ (2001) Parathyroid crisis in a 20 year old – an unusual cause of hypercalcaemic crisis. Postgrad Med J 77(909):468–470CrossRefPubMedGoogle Scholar
  36. 36.
    Peacock M, Bilezikian JP, Klassen PS, Guo MD, Turner SA, Shoback D (2005) Cinacalcet hydrochloride maintains long-term normocalcemia in patients with primary hyperparathyroidism. J Clin Endocrinol Metab 90(1):135–141CrossRefPubMedGoogle Scholar
  37. 37.
    Kaplan EL, Yashiro T, Salti G (1992) Primary hyperparathyroidism in the 1990s. Choice of surgical procedures for this disease. Ann Surg 215(4):300–317Google Scholar
  38. 38.
    Sosa JA, Powe NR, Levine MA, Udelsman R, Zeiger MA (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(8):2658–2665CrossRefPubMedGoogle Scholar
  39. 39.
    Eigelberger MS, Clark OH (2000) Surgical approaches to primary hyperparathyroidism. Endocrinol Metab Clin North Am 29(3):479–502CrossRefPubMedGoogle Scholar
  40. 40.
    McGill J, Sturgeon C, Kaplan SP, Chiu B, Kaplan EL, Angelos P (2008) How does the operative strategy for primary hyperparathyroidism impact the findings and cure rate? A comparison of 800 parathyroidectomies. J Am Coll Surg 207(2):246–249CrossRefPubMedGoogle Scholar
  41. 41.
    Beyer TD, Solorzano CC, Prinz RA, Babu A, Nilubol N, Patel S (2007) Oral vitamin D supplementation reduces the incidence of eucalcemic PTH elevation after surgery for primary hyperparathyroidism. Surgery 141(6):777–783CrossRefPubMedGoogle Scholar
  42. 42.
    Grubbs EG, Rafeeq S, Jimenez C, et al (2008) Preoperative vitamin D replacement therapy in primary hyperparathyroidism: safe and beneficial? Surgery 144(6):852–858; discussion 8–9Google Scholar
  43. 43.
    Yen TW, Wilson SD, Krzywda EA, Sugg SL (2006) The role of parathyroid hormone measurements after surgery for primary hyperparathyroidism. Surgery 140(4):665–672; discussion 72–74Google Scholar
  44. 44.
    Ning L SR, Schaefer S, and Chen H (2009) What is the clinical significance of an elevated parathyroid hormone level after curative surgery for primary hyperparathyroidism? Ann Surg 249(3):469–472Google Scholar
  45. 45.
    Egan KR, Adler JT, Olson JE, Chen H (2007) Parathyroidectomy for primary hyperparathyroidism in octogenarians and nonagenarians: a risk-benefit analysis. J Surg Res 140(2):194–198CrossRefPubMedGoogle Scholar
  46. 46.
    Burney RE, Jones KR, Peterson M, Christy B, Thompson NW (1998) Surgical correction of primary hyperparathyroidism improves quality of life. Surgery 124(6):987–991; discussion 91–92Google Scholar
  47. 47.
    Roman S, Sosa JA (2007) Psychiatric and cognitive aspects of primary hyperparathyroidism. Curr Opin Oncol 19(1):1–5CrossRefPubMedGoogle Scholar
  48. 48.
    Eigelberger MS, Cheah WK, Ituarte PH, Streja L, Duh QY, Clark OH (2004) The NIH criteria for parathyroidectomy in asymptomatic primary hyperparathyroidism: are they too limited? Ann Surg 239(4):528–535CrossRefPubMedGoogle Scholar
  49. 49.
    Adler JT, Sippel RS, Chen H (2008) The influence of surgical approach on quality of life after parathyroid surgery. Ann Surg Oncol 15(6):1559–1565CrossRefPubMedGoogle Scholar
  50. 50.
    Vestergaard P, Mollerup CL, Frokjaer VG, Christiansen P, Blichert-Toft M, Mosekilde L (2000) Cohort study of risk of fracture before and after surgery for primary hyperparathyroidism. BMJ 321(7261):598–602CrossRefPubMedGoogle Scholar
  51. 51.
    Vestergaard P, Mollerup CL, Frokjaer VG, Christiansen P, Blichert-Toft M, Mosekilde L (2003) Cardiovascular events before and after surgery for primary hyperparathyroidism. World J Surg 27(2):216–222PubMedGoogle Scholar
  52. 52.
    Cohen MS, Dilley WG, Wells SA Jr, et al (2005) Long-term functionality of cryopreserved parathyroid autografts: a 13-year prospective analysis. Surgery 138(6):1033–1040; discussion 40–41Google Scholar
  53. 53.
    Bergenfelz A, Lindblom P, Tibblin S, Westerdahl J (2002) Unilateral versus bilateral neck exploration for primary hyperparathyroidism: a prospective randomized controlled trial. Ann Surg 236(5):543–551CrossRefPubMedGoogle Scholar
  54. 54.
    Caron NR, Sturgeon C, Clark OH (2004) Persistent and recurrent hyperparathyroidism. Curr Treat Options in Oncol 5(4):335–345CrossRefGoogle Scholar
  55. 55.
    Shen W, Duren M, Morita E, et al (1996) Reoperation for persistent or recurrent primary hyperparathyroidism. Arch Surg 131(8):861–867; discussion 7–9Google Scholar
  56. 56.
    Mariette C, Pellissier L, Combemale F, Quievreux JL, Carnaille B, Proye C (1998) Reoperation for persistent or recurrent primary hyperparathyroidism. Langenbecks Arch Surg 383(2):174–179PubMedGoogle Scholar
  57. 57.
    Lo CY, Kung AW, Lam KS (1997) Surgical treatment for primary hyperparathyroidism. Chin Med J (Engl) 110(8):612–616Google Scholar
  58. 58.
    Jaskowiak N, Norton JA, Alexander HR, et al (1996) A prospective trial evaluating a standard approach to reoperation for missed parathyroid adenoma. Ann Surg 224(3):308–320; discussion 20–21Google Scholar

Copyright information

© Springer Science+Business Media, LLC 2010

Authors and Affiliations

  • Kaitlyn J. Kelly
  • Herbert Chen
  • Rebecca S. Sippel
    • 1
  1. 1.University of Wisconsin Hospital and ClinicsMadisonUSA

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