Medical management of primary hyperparathyroidism

Abstract

Primary hyperparathyroidism (PHPT) is an endocrine disorder resulting from the hyperfunction of one or more parathyroid glands, with hypersecretion of parathyroid hormone (PTH). It can be managed by parathyroidectomy (PTX) or non-surgically. Medical therapy with pharmacological agents is an alternative for those patients with asymptomatic PHPT who meet guidelines for surgery but are unable or unwilling to undergo PTX. In this review, we focus upon these non-surgical aspects of PHPT management. We emphasize the most studied and widely used pharmacological alternatives: bisphosphonates, denosumab, cinacalcet and hormone therapy, in addition to combined therapy. We also address the relevant aspects of perioperative management.

Hyper- und Hypokalzämie: Was gibt es zu beachten?

“…Nach erfolgter Diagnosestellung eines pHPT (oder Nebenschilddrüsenkarzinoms) als Ursache der Hyperkalzämie kann eine effektive Kalziumsenkung über das Kalzimimetikum Cinacalcet erfolgen [6]. Die kausale Therapie dieser Erkrankungen wäre allerdings die chirurgische Parathyreoidektomie.…”

Introductory Chapter: A Brief Statement about Parathyroid Glands

“…One or very rarely two of the glands may overproduce PTH. After the exact diagnosis, it is possible to treat by surgical intervention [6][7][8]. Another type of hyperparathyroidism is paraneoplastic hyperparathyroidism, which is very rare.…”

Diagnostic utility of 11C‐methionine PET/CT in primary hyperparathyroidism in a UK cohort: A single‐centre experience and literature review

“…Medical options include cinacalcet to reduce serum calcium levels, alendronate or denosumab to increase bone mineral density, and vitamin D supplementation to prevent disease progression. 7,8 However, parathyroidectomy remains the definitive treatment option for symptomatic PHPT or for patients with end-organ complications. Surgical cure can be achieved in the majority of cases and is aided by localisation of a target parathyroid adenoma on preoperative imaging.…”

“…Current guidelines recommend medical management for asymptomatic PHPT without end‐organ damage or for patients not eligible for surgical management. Medical options include cinacalcet to reduce serum calcium levels, alendronate or denosumab to increase bone mineral density, and vitamin D supplementation to prevent disease progression 7,8 . However, parathyroidectomy remains the definitive treatment option for symptomatic PHPT or for patients with end‐organ complications.…”