IBMS BoneKEy | Perspective

The treatment of primary hyperparathyroidism

Esteban Jódar Gimeno
Manuel Muñoz-Torres

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DOI:10.1138/20110524

Abstract

The clinical profile of primary hyperparathyroidism (PHP) has experienced substantial changes in the last few decades, and the appropriate treatment of patients with this disease continues to generate significant controversy. In its different forms of presentation (symptomatic, subclinical or asymptomatic) the appropriate treatment of patients with PHP has been addressed in different consensus statements and clinical guidelines published in the last 20 years. The most recent document (Guidelines for the Management of Asymptomatic Primary Hyperparathyroidism: Summary Statement from the Third International Workshop. J Clin Endocrinol Metab. 2009 Feb;94(2):335-9) has established new criteria by which parathyroidectomy should be indicated. Nevertheless, the true natural history of PHP is not well-known, and the available scientific evidence is limited. Parathyroidectomy is the only definitive treatment for PHP, and all symptomatic patients ought to receive this intervention, except in cases of medical contraindication, or if the patient does not wish it. In recent years the development of a calcimimetic drug such as cinacalcet, which reduces blood concentrations of calcium and PTH, has become an attractive alternative for those patients in whom surgery is contraindicated or is not clinically appropriate. In short, a more proactive approach towards surgical treatment should be recommended, although there is a role for conservative management or medical treatment.

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