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An overview of normocalcemic primary hyperparathyroidism

Pawlowska, Monikaa; Cusano, Natalie E.b

Current Opinion in Endocrinology, Diabetes and Obesity: December 2015 - Volume 22 - Issue 6 - p 413–421
doi: 10.1097/MED.0000000000000198

Purpose of review Normocalcemic primary hyperparathyroidism (PHPT) received special attention in the publication of the conference proceedings from the Fourth International Workshop on the Management of Asymptomatic PHPT, although much remains unknown about the disorder.

Recent findings Observational studies have found that despite maintaining normocalcemia, patients with normocalcemic PHPT have a high incidence of kidney stones and osteoporosis. Small studies focusing on the cardiovascular implications of normocalcemic PHPT have shown a possible association with hypertension and an atherogenic lipid profile, but not insulin resistance. Recent data from small cohorts show that subjects with normocalcemic PHPT respond to medical therapy and have a positive densitometric response following parathyroid surgery.

Summary The available evidence suggests that patients with normocalcemic PHPT develop complications of PHPT, despite having normal calcium levels. Most data come from referral populations and information regarding a mild, asymptomatic form of the disease is lacking. Future research requires a standardized approach to the diagnostic criteria of normocalcemic PHPT.

aDepartment of Medicine, Division of Endocrinology, University of British Columbia, Vancouver, British Columbia

bDepartment of Medicine, Division of Endocrinology, Columbia University, New York, New York, USA

Correspondence to Natalie E. Cusano, 630 West 168th St., PH8W-864, New York, NY 10032, USA. Tel: +1 212 305 2801; fax: +1 212 305 6486; e-mail:

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