title: Medical management of primary hyperparathyroidism: proceedings of the fourth International Workshop on the Management of Asymptomatic Primary Hyperparathyroidism.
abstract: OBJECTIVE
  Asymptomatic primary hyperparathyroidism (PHPT) is a common clinical problem. The only available definitive therapy is parathyroidectomy, which is appropriate to consider in all patients. The purpose of this report is to provide an update on calcium and vitamin D supplementation and medical management for those patients with PHPT who cannot or do not want to undergo surgery.
  
  
  METHODS
  Questions were developed by the International Task Force on PHPT. A comprehensive literature search was undertaken, and relevant articles published between 2008 and 2013 were reviewed in detail. The questions were addressed by the panel of experts, and consensus was established at the time of the workshop.
  
  
  CONCLUSIONS
  The recommended calcium intake in patients with PHPT should follow guidelines established for all individuals. It is not recommended to limit calcium intake in patients with PHPT who do not undergo surgery. Patients with low serum 25-hydroxyvitamin D should be repleted with doses of vitamin D aiming to bring serum 25-hydroxyvitamin D levels to ≥ 50 nmol/L (20 ng/mL) at a minimum, but a goal of ≥75 nmol/L (30 ng/mL) also is reasonable. Pharmacological approaches are available and should be reserved for those patients in whom it is desirable to lower the serum calcium, increase BMD, or both. For the control of hypercalcemia, cinacalcet is the treatment of choice. Cinacalcet reduces serum calcium concentrations to normal in many cases, but has only a modest effect on serum PTH levels. However, bone mineral density (BMD) does not change. To improve BMD, bisphosphonate therapy is recommended. The best evidence is for the use of alendronate, which improves BMD at the lumbar spine without altering the serum calcium concentration. To reduce the serum calcium and improve BMD, combination therapy with both agents is reasonable, but strong evidence for the efficacy of that approach is lacking.
authors.affiliation: Department of Clinical and Experimental Medicine (C.M.), University of Pisa, and Endocrine Unit 2, University Hospital of Pisa, 56124 Pisa, Italy; Section of Specialized Endocrinology (J.B.), Oslo University Hospital, Rikshospitalet and Faculty of Medicine, University of Oslo, N-0027 Oslo, Norway; Department of Medicine, Divisions of Endocrinology and Geriatrics (A.A.K.), McMaster University, Hamilton, ON, Canada L8N4A6; and Endocrine Research Unit (D.M.S.), San Francisco Veterans Affairs Medical Center and Department of Medicine, University of California, San Francisco, California 94143.
authors.forename: Claudio
authors.initials: C
authors.lastname: Marcocci
authors.forename: Jens
authors.initials: J
authors.lastname: Bollerslev
authors.forename: Aliya Aziz
authors.initials: AA
authors.lastname: Khan
authors.forename: Dolores Marie
authors.initials: DM
authors.lastname: Shoback
mesh_terms: D058070:Asymptomatic Diseases / Q000628:therapy*; D002118:Calcium / Q000627:therapeutic use*; D019587:Dietary Supplements; D004493:Education; D004704:Endocrinology / Q000592:standards*; D006801:Humans; D049950:Hyperparathyroidism, Primary / Q000188:drug therapy*; D017410:Practice Guidelines as Topic; D014807:Vitamin D / Q000627:therapeutic use*; D014815:Vitamins / Q000627:therapeutic use
chemical_list: D014815:Vitamins; D014807:Vitamin D; D002118:Calcium