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2014 ; 19
(9
): 919-29
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Mild primary hyperparathyroidism: a literature review
#MMPMID25063228
Applewhite MK
; Schneider DF
Oncologist
2014[Sep]; 19
(9
): 919-29
PMID25063228
show ga
The biochemical profile of classic primary hyperparathyroidism (pHPT) consists of
both elevated calcium and parathyroid hormone levels. The standard of care is
parathyroidectomy unless prohibited by medical comorbidities. Because more
patients are undergoing routine bone density evaluation and neck imaging studies
for other purposes, there is a subset of people identified with a biochemically
mild form of the pHPT that expresses itself as either elevated calcium or
parathyroid hormone levels. These patients often do not fall into the criteria
for operation based on the National Institutes of Health consensus guidelines,
and they can present a challenge of diagnosis and management. The purpose of this
paper is to review the available literature on mild pHPT in an effort to better
characterize this patient population and to determine whether patients benefit
from parathyroidectomy. Evidence suggests that there are patients with mild pHPT
who have overt symptoms that are found to improve after parathyroidectomy. There
is also a group of patients with biochemically mild pHPT who are found to
progress to classic pHPT over time; however, it is not predictable which group of
patients this will be. Early intervention for this group with mild pHPT may
prevent progression of bone, psychiatric, and renal complications, and
parathyroidectomy has proven safe in appropriately selected patients at high
volume centers.
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