Primary hyperparathyroidism: review and recommendations on evaluation, diagnosis, and management. A Canadian and international consensus.
The purpose of this review is to assess the most recent evidence in the management of primary hyperparathyroidism (PHPT) and provide updated recommendations for its evaluation, diagnosis and treatment. A Medline search of "Hyperparathyroidism. Primary" was conducted and the literature with the highest levels of evidence were reviewed and used to formulate recommendations. PHPT is a common endocrine disorder usually discovered by routine biochemical screening. PHPT is defined as hypercalcemia with increased or inappropriately normal plasma parathyroid hormone (PTH). It is most commonly seen after the age of 50 years, with women predominating by three to fourfold. In countries with routine multichannel screening, PHPT is identified earlier and may be asymptomatic. Where biochemical testing is not routine, PHPT is more likely to present with skeletal complications, or nephrolithiasis. Parathyroidectomy (PTx) is indicated for those with symptomatic disease. For asymptomatic patients, recent guidelines have recommended criteria for surgery, however PTx can also be considered in those who do not meet criteria, and prefer surgery. Non-surgical therapies are available when surgery is not appropriate. This review presents the current state of the art in the diagnosis and management of PHPT and updates the Canadian Position paper on PHPT. An overview of the impact of PHPT on the skeleton and other target organs is presented with international consensus. Differences in the international presentation of this condition are also summarized.
McMaster University, Hamilton, Canada. Aliya@mcmaster.ca.|Bone Research and Education Center, 223-3075 Hospital Gate, Oakville, ON, Canada. Aliya@mcmaster.ca.
A A
AA
Khan
University of Calgary, Calgary, Canada.
D A
DA
Hanley
Division of Bone Diseases, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland.
R
R
Rizzoli
University of Oslo, Oslo, Norway.
J
J
Bollerslev
McMaster University, Hamilton, Canada.
J E M
JE
Young
Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus, Denmark.
L
L
Rejnmark
University of Oxford, Oxford, UK.
R
R
Thakker
CHUM, Montreal, Canada.
P
P
D'Amour
Western University, London, ON, Canada.
T
T
Paul
Western University, London, ON, Canada.
S
S
Van Uum
Division of Endocrinology, University of Toronto, Mississauga, ON, Canada.
M Zakaria
MZ
Shrayyef
McGill University, Montreal, Canada.
D
D
Goltzman
Dalhousie University, Halifax, Canada.
S
S
Kaiser
Columbia University College of Physicians and Surgeons, New York, NY, USA.
N E
NE
Cusano
KU, Leuven, Belgium.
R
R
Bouillon
University of Aarhus, Aarhus, Denmark.
L
L
Mosekilde
University of Hong Kong, Hong Kong, China.
A W
AW
Kung
Henry Ford Hospital, Detroit, MI, USA.
S D
SD
Rao
Postgraduate Institute of Medical Education and Research, Chandigarth, India.
S K
SK
Bhadada
Mayo Clinic, Rochester, MN, USA.
B L
BL
Clarke
Rui-Jin Hospital, Shanghai Jiao-Tong University School of Medicine, Shanghai, China.
J
J
Liu
University of California, San Francisco, CA, USA.
Q
Q
Duh
New Mexico Clinical Research and Osteoporosis Center, University of New Mexico School of Medicine, Albuquerque, NM, USA.
E Michael
EM
Lewiecki
Division of Endocrinology, Diabetes and Metabolic Bone Diseases, Agamenon Magalhaes Hospital, Brazilian Ministry of Health, University of Pernambuco Medical School, Recife, Brazil.
F
F
Bandeira
Department of Human Metabolism, University of Sheffield, Sheffield, UK.
R
R
Eastell
Department for Clinical and Experimental Medicine, University of Pisa, Endocrine Unit 2, University Hospital of Pisa, Pisa, Italy.
C
C
Marcocci
Division of Endocrinology, Columbia University College of Physicians and Surgeons, New York, NY, USA.
S J
SJ
Silverberg
Department of Surgery, Yale University School of Medicine, New Haven, CT, USA.
R
R
Udelsman
University of Victoria, Victoria, BC, Canada.
K Shawn
KS
Davison
Massachusetts General Hospital, Harvard University, Boston, MA, USA.
J T
JT
Potts
University of Florence, Florence, Italy.
M L
ML
Brandi
Division of Endocrinology, Columbia University College of Physicians and Surgeons, New York, NY, USA.
J P
JP
Bilezikian
D006801:Humans; D006934:Hypercalcemia / Q000209:etiology; D049950:Hyperparathyroidism, Primary / Q000150:complications / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000628:therapy; D015994:Incidence; D008279:Magnetic Resonance Imaging / Q000379:methods; D053040:Nephrolithiasis / Q000209:etiology; D016105:Parathyroidectomy; D015995:Prevalence; D011877:Radionuclide Imaging / Q000379:methods; D014057:Tomography, X-Ray Computed / Q000379:methods
Diagnosis; Management; Osteoporosis; Primary hyperparathyroidism; Surgery; Treatment