Hyperparathyroidism: Symptomatic, Asymptomatic and Its Management Updates

Primary hyperparathyroidism is the most common cause of hypercalcemia in outpatients. In the Western world, most patients with PHPT present with nonspecific symptoms such as fatigue, mood disturbances, and cognitive impairments. Atypical presentations include a spectrum of disturbances in calcium homeostasis, ranging from symptomatic severe hypercalcemia (parathyroid crisis) to normocalcemic PHPT. Diagnosis is established when intact parathyroid hormone levels are elevated or at the high end of the normal range in the setting of elevated total or ionized calcium levels (following exclusion of conditions that can mimic PHPT). Criteria for surgery have recently been modified. Surgical guidelines for PHPT have been developed based upon risk for end-organ effects and for disease progression. Surgery is always a suitable option in those with symptomatic PHPT and no contraindications. Localization studies with ultrasonography, technetium-99m sestamibi, computed tomography (CT), or magnetic resonance imaging (MRI) scanning should be done after a decision for surgery has been made. Those with contraindications or with asymptomatic PHPT not meeting the criteria for surgery can generally be safely monitored and considered for medical management. For asymptomatic individuals who do not meet surgical criteria, monitoring of serum calcium and creatinine annually and bone density (hip, spine, and forearm) may have done every one to two years shoule be advised . medical management might include treatment with bisphosphonates, denosumab , or calcimimetic agents. The session will discuss about diagnostic testing and assessment in primary and secondary care,referral for surgery,surgical and non surgical management,monitoring, and special aspects such as normocalcemic hyperparathyroidism and hyperparathyroidism and pregnancy.