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The diagnosis and management of asymptomatic primary hyperparathyroidism

Nature Clinical Practice Endocrinology & Metabolism volume 2, pages 494–503 (2006)Cite this article

Abstract

Classical primary hyperparathyroidism—a disease of 'bones, stones, and psychic groans'—is a rarity in the US, although it is still seen in some parts of the world. Today, most patients with primary hyperparathyroidism are asymptomatic. This change in clinical profile is not merely because of improved detection techniques, and patients with primary hyperparathyroidism who lack symptoms, if left untreated, rarely develop the 'classical' features that were common previously. Indeed, currently available data suggest that there is, today, a disorder with different, yet characteristic, effects on the end-organs of the hyperparathyroid process. In this review, the features of the skeletal, renal, neuropsychologic, cardiovascular, and gastrointestinal manifestations of 'asymptomatic' primary hyperparathyroidism will be discussed. The considerable body of data that has emerged since the recognition of the new clinical profile of primary hyperparathyroidism has allowed a reconsideration of standards of care for this disease. These data were reviewed and incorporated into new clinical guidelines at the 2002 NIH workshop on asymptomatic primary hyperparathyroidism. These recommendations highlight both what is known about the disease, and important areas that need investigation. Continued interest in the skeletal, cardiovascular, and neuropsychiatric manifestations of the disease, and therapeutic trials of medical approaches for its management, will further refine our current understanding, and could lead to additional modifications in the approach to patients with this common endocrine disorder.

Key Points

  • Classical primary hyperparathyroidism is rarely seen today; the vast majority of patients with this disease are asymptomatic

  • The change in clinical profile of modern primary hyperparathyroidism is not caused exclusively by improved detection techniques, as patients with the disorder, if left untreated, do not tend to develop the classical features of its predecessor

  • The disease, although much changed, has distinctive clinical effects on the target organs of parathyroid hormone excess

  • Surgery remains the only curative treatment for primary parathyroidism; new evidence-based guidelines issued in 2002 after an NIH workshop are the current standard of care for intervention in this disease

  • Future research directions (including neuropsychologic and cardiovascular involvement, medical treatment options, new surgical approaches etc.) could lead to further refinements in the approach to this disorder

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Acknowledgements

Our research is supported by grants DDK66329 and DDK32333 from the NIH.

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Authors and Affiliations

  1. Columbia University,

    Shonni J Silverberg & John P Bilezikian

  2. College of Physicians and Surgeons of Columbia University,

    Shonni J Silverberg & John P Bilezikian

  3. Division of Endocrinology,

    Shonni J Silverberg & John P Bilezikian

  4. Columbia University Medical Center, New York City, NY, USA

    Shonni J Silverberg & John P Bilezikian

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Correspondence to Shonni J Silverberg.

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Drs Silverberg and Bilezikian have received research support from Amgen and Merck. Dr Bilezikian is also a consultant for both Amgen and Merck.

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Silverberg, S., Bilezikian, J. The diagnosis and management of asymptomatic primary hyperparathyroidism. Nat Rev Endocrinol 2, 494–503 (2006). https://doi.org/10.1038/ncpendmet0265

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