Purpose of review
Primary hyperparathyroidism is the third most common endocrine disorder and the second most common cause of hypercalcemia. Because of the changing patterns of presentation, currently, a vast majority of patients with this disease are asymptomatic, and the role of parathyroidectomy has been called into question. However, emergence of minimally invasive parathyroidectomy and concern about nonclassical manifestations of the disease has rekindled interest in a more liberal approach to surgery. Therefore, it is appropriate to review the state of the management of primary hyperparathyroidism.
Modern day primary hyperparathyroidism is largely asymptomatic, rarely presents with classic bone disease or recurrent stones, and in the absence of treatment the disease course remains stable over extended periods. However, there is growing concern about nonclassical manifestations of the disease such as cardiovascular disease, hypertension, dyslipidemia, and diabetes, resulting in excess mortality. It is argued that parathyroidectomy reduces this risk. Although surgery is the treatment of choice for patients with symptomatic disease, uncertainty exists about its benefits in mild asymptomatic disease. Availability of effective therapies that increase bone density has added a new dimension in the management of such patients.
Changing incidence and patterns of presentation of primary hyperparathyroidism have created a dilemma for today's clinician to decide on the optimal management of patients with this disease. Advances in surgical techniques and the availability of drugs to increase bone density have added new dimensions to the management of this common endocrine disorder.