Current Issues in the Presentation of Asymptomatic Primary Hyperparathyroidism: Proceedings of the Fourth International Workshop

Abstract

1) There are limited new data available on the natural history of asymptomatic PHPT. Although recognition of normocalcemic PHPT (normal serum calcium with elevated PTH concentrations; no secondary cause for hyperparathyroidism) is increasing, data on the clinical presentation and natural history of this phenotype are limited. 2) Although there are geographic differences in the predominant phenotypes of PHPT (symptomatic, asymptomatic, normocalcemic), they do not justify geography-specific management guidelines. 3) Recent data using newer, higher resolution imaging and analytic methods have revealed that in asymptomatic PHPT, both trabecular bone and cortical bone are affected. 4) Clinically silent nephrolithiasis and nephrocalcinosis can be detected by renal imaging and should be listed as a new criterion for surgery. 5) Current data do not support a cardiovascular evaluation or surgery for the purpose of improving cardiovascular markers, anatomical or functional abnormalities. 6) Some patients with mild PHPT have neuropsychological complaints and cognitive abnormalities, and some of these patients may benefit from surgical intervention. However, it is not possible at this time to predict which patients with neuropsychological complaints or cognitive issues will improve after successful parathyroid surgery.

Renal Manifestation in Patients with Primary Hyperparathyroidism: a Retrospective Analysis in a Tertiary Institute

“…In Western countries, the prevalence of renal stone disease has decreased from approximately from 80 % to 7-20 % in recent years (1). European data showed 25.4% rate of renal calcifications in PHPT (7) and another study reported only 19 (7.0%) of the 271 patients with mild PHPT had renal stones, detected by the renal ultasonogram (8).…”

“…It is most commonly seen after the age of 50 years, with women predominating by three to fourfold. PHPT is the most common cause of hypercalcemia in otherwise healthy patients (1). The clinical presentation of PHPT reflects the combined effects of hypercalcemia and 32 increased PTH level.…”

Parathyroid hormone reflects adiposity and cardiometabolic indices but not bone density in normal men

“…Potential consequences of PTH excess include accelerated bone loss and fragility fracture, nephrolithiasis, renal impairment, increased cardiovascular risk, and in the settting of primary hyperparathyroidism, symptomatic hypercalcemia. 1 Vitamin D deficiency, renal dysfunction, hypercalciuria, malabsorption and the use of medications (for example, lithium) are recognized causes of secondary hyperparathyroidism. 2 Although not typically considered causes of secondary hyperparathyroidism, characteristics such as age, fat mass and blood pressure have previously been shown to be independently associated with circulating PTH concentrations.…”

“…[13][14][15] Thus, it is unclear whether normocalcemic hyperparathyroidism is a discrete pathological entity with real associated morbidity, and there is currently no consensus regarding its management. 1 It is not clear whether the deleterious associations of PTH that have been documented in some cohorts with normocalcemic hyperparathyroidism manifest because PTH exceeds a certain 'cut point', or whether the disease associations are linear. In the present investigation, we have identified a cohort of healthy men, free of referral bias and assessed relationships between serum PTH and specific pathologies (skeletal and cardiometabolic), with a view to determine whether these pathologies are associated with high-normal PTH levels.…”

¿Son válidos los criterios quirúrgicos actuales del hiperparatiroidismo primario asintomático?

“…It being preferable to avoid these complications before they occur, there is a discussion as to when it is advisable to intervene surgically in a patient who is clinically asymptomatic. To throw light on this matter a number of position documents have been published [5][6][7][8][9][10] , without there being unanimous agreement [2][3][4]10,11 . Techniques such as bone densitometry help to establish the existence of osteoporosis as a complication 3,6 , and recently a new technique has been introduced, the trabecular bone score (TBS), which is intended to evaluate the integrity and connectivity of the trabeculae of the vertebrae [12][13][14][15] , with some studies having been published which show the early effects of PHPT [14][15][16] .…”