Asymptomatic Primary Hyperparathyroidism

Silverberg, Shonni J.; Bilezikian, John P.

doi:10.1016/b978-0-12-397166-1.00021-7

Cited by 7 publications

(8 citation statements)

References 139 publications

(53 reference statements)

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“…When patients with PHPT develop hypercalciuria, the filtered calcium load is greater than the capacity of the kidney to reabsorb calcium efficiently, even under the influence of PTH 42 .…”

Section: Mechanisms/pathophysiologymentioning

confidence: 99%

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Primary hyperparathyroidism

Bilezikian

Cusano

Khan

et al. 2016

Nat Rev Dis Primers

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209

166

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Primary hyperparathyroidism (PHPT) is a common disorder in which parathyroid hormone (PTH) is excessively secreted from one or more of the four parathyroid glands. A single benign parathyroid adenoma is the cause in most people. However, multiglandular disease is not rare and is typically seen in familial PHPT syndromes. The genetics of PHPT is usually monoclonal when a single gland is involved and polyclonal when multiglandular disease is present. The genes that have been implicated in PHPT include proto-oncogenes and tumour-suppressor genes. Hypercalcaemia is the biochemical hallmark of PHPT. Usually, the concentration of PTH is frankly increased but can remain within the normal range, which is abnormal in the setting of hypercalcaemia. Normocalcaemic PHPT, a variant in which the serum calcium level is persistently normal but PTH levels are increased in the absence of an obvious inciting stimulus, is now recognized. The clinical presentation of PHPT varies from asymptomatic disease (seen in countries where biochemical screening is routine) to classic symptomatic disease in which renal and/or skeletal complications are observed. Management guidelines have recently been revised to help the clinician to decide on the merits of a parathyroidectomy or a non-surgical course. This Primer covers these areas with particular attention to the epidemiology, clinical presentations, genetics, evaluation and guidelines for the management of PHPT.

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“…When patients with PHPT develop hypercalciuria, the filtered calcium load is greater than the capacity of the kidney to reabsorb calcium efficiently, even under the influence of PTH 42 .…”

Section: Mechanisms/pathophysiologymentioning

confidence: 99%

“…After parathyroidectomy, BMD increases even in patients with mild disease. When PHPT is associated with osteitis fibrosa cystica, the improvement in BMD can be so marked as to increase into the normal range 42,102 .…”

Section: Diagnosis Screening and Preventionmentioning

confidence: 99%

Primary hyperparathyroidism

Bilezikian

Cusano

Khan

et al. 2016

Nat Rev Dis Primers

Self Cite

209

166

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“…Owing to the prevalence of asymptomatic PHPT, OFC is rarely seen these days in developed countries. However, skeletal involvement continues to be readily detected by technologies such as DXA 15 , 21 . Reduced BMD is observed most often in distal 1/3 radius site, comprised mostly of cortical bone, with relative preservation of lumbar spine, a site that is endowed primarily with trabecular bone 22 .…”

Section: Clinical Presentationmentioning

confidence: 99%

“…These new imaging technologies have revealed abnormalities in trabecular bone in addition to the well-known cortical involvement in PHPT. They help to resolve the clinical paradox of relatively normal lumbar spine BMD by DXA in the context of an increase in VFs in PHPT 21 , 22 .…”

Section: Clinical Presentationmentioning

confidence: 99%

Primary Hyperparathyroidism

Bandeira

Bilezikian

2016

F1000Res

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Over the past several generations, primary hyperparathyroidism (PHTP) has undergone a change in its clinical presentation in many countries from a symptomatic disease to an asymptomatic one. The reasons for this change in clinical presentation are related to the widespread use of biochemical screening tests, to the measurement of PTH more routinely in the evaluation of metabolic bone disease and to the status of vitamin D sufficiency in the population. Along with recognition of a broader clinical spectrum of disease, including a more recently recognized normocalcemic variant, has come an appreciation that the evaluation of classic target organs that can be affected in PHPT, such as the skeleton and the kidneys, require more advanced imaging technology for complete evaluation. It is clear that even in asymptomatic patients, evidence for microstructural disease in the skeleton and calcifications in the kidneys can be demonstrated often. Potential non-classical manifestations of PHPT related to neurocognition and the cardiovascular system continue to be of interest. As a result of these advances, revised guidelines for the management of asymptomatic PHPT have been recently published to help the clinician determine whether surgery is appropriate or whether a more conservative approach is acceptable.

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“…It is now described as a common disorder, especially in middle-aged and elderly women, presenting with no or only mild symptoms. (1)(2)(3)(4) Bone is the classical target organ in PHPT, and it is well known that bone turnover is reversibly increased in these patients, resulting in decreased bone mineral density (BMD). (4,5) Parathyroidectomy (PTX), being the curative treatment, results in an increase in BMD mainly in trabecular-rich sites (6)(7)(8)(9)(10)(11)(12) with stable results for up to 15 years.…”

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confidence: 99%

Effect of Surgery Versus Observation: Skeletal 5-Year Outcomes in a Randomized Trial of Patients With Primary HPT (the SIPH Study)

Lundstam

Heck

Godang

et al. 2017

Journal of Bone and Mineral Research

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Mild primary hyperparathyroidism (PHPT) is known to affect the skeleton, even though patients usually are asymptomatic. Treatment strategies have been widely discussed. However, long-term randomized studies comparing parathyroidectomy to observation are lacking. The objective was to study the effect of parathyroidectomy (PTX) compared with observation (OBS) on bone mineral density (BMD) in g/cm and T-scores and on biochemical markers of bone turnover (P1NP and CTX-1) in a prospective randomized controlled study of patients with mild PHPT after 5 years of follow-up. Of 191 patients with mild PHPT randomized to either PTX or OBS, 145 patients remained for analysis after 5 years (110 with validated DXA scans). A significant decrease in P1NP (p < 0.001) and CTX-1 (p < 0.001) was found in the PTX group only. A significant positive treatment effect of surgery compared with observation on BMD (g/cm ) was found for the lumbar spine (LS) (p = 0.011), the femoral neck (FN) (p < 0.001), the ultradistal radius (UDR) (p = 0.042), and for the total body (TB) (p < 0.001) but not for the radius 33% (Rad33), where BMD decreased significantly also in the PTX group (p = 0.012). However, compared with baseline values, there was no significant BMD increase in the PTX group, except for the lumbar spine. In the OBS group, there was a significant decrease in BMD (g/cm ) for all compartments (FN, p < 0.001; Rad33, p = 0.001; UDR, p = 0.006; TB, p < 0.001) with the exception of the LS, where BMD was stable. In conclusion, parathyroidectomy improves BMD and observation leads to a small but statistically significant decrease in BMD after 5 years. Thus, bone health appears to be a clinical concern with long-term observation in patients with mild PHPT. © 2017 American Society for Bone and Mineral Research.

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Asymptomatic Primary Hyperparathyroidism

Cited by 7 publications

References 139 publications

Primary hyperparathyroidism

Primary hyperparathyroidism

Primary Hyperparathyroidism

Effect of Surgery Versus Observation: Skeletal 5-Year Outcomes in a Randomized Trial of Patients With Primary HPT (the SIPH Study)

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