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lüll Therapeutic controversies in primary hyperparathyroidism Silverberg SJ; Bilezikian JP; Bone HG; Talpos GB; Horwitz MJ; Stewart AFJ Clin Endocrinol Metab 1999[Jul]; 84 (7): 2275-85There is little debate about the primacy of surgery in the management of classical PHPT. Rather, the question has been what to do about the many patients with nonclassical disease. A 1990 NIH consensus conference (55) clearly recommended surgery for patients with significant adverse effects of PHPT, for patients with complicating coexistent illnesses, for younger patients, and for those in whom consistent long-term follow-up could not be assured. It allowed that conscientious surveillance may be justified in patients with minimal hypercalcemia and no adverse effects, but it recognized that for many patients, the time and expense involved in rigorous follow-up would outweigh the burden of surgery. Nine years later, the demonstrated prevalence of nonclassical symptoms and their reversibility, the evidence of "asymptomatic" but harmful effects reversible by surgery, and the accumulating evidence for surgical reduction of increased long-term mortality risk substantially strengthen the argument for surgery in such patients. For these reasons, parathyroidectomy should generally be recommended for patients with a secure diagnosis of PHPT, even in the absence of classical symptoms.|*Parathyroidectomy[MESH]|Calcium/blood[MESH]|Consensus Development Conferences, NIH as Topic[MESH]|Humans[MESH]|Hyperparathyroidism/diagnosis/mortality/*surgery[MESH]|Parathyroid Hormone/blood[MESH]|United States[MESH] |