Endocrine Abstracts

Primary hyperparathyroidism (PHPT) is the most common cause of hypercalcemia. It is frequently identified in women, usually in their postmenopausal years, with a female/male ratio of, on average, 3:1. The prevalence of PHPT is known to vary by country and race. It is currently recognised that PHPT includes three clinical phenotypes: hypercalcaemia with overt target organ involvement, mild asymptomatic hypercalcemia with or without target organ involvement, and normocalcaemic hyperparathyroidism (NPHPT) with or without target organ involvement. It is important that a robust clinical and biochemical diagnosis of PHPT is established before consideration of appropriate management. The gold standard for PHPT and NPHPT management is surgery and should be recommended to those who meet any one of the criteria for surgery¹: Age <50 years; hypercalcaemia > 0.25 mmol/l (1 mg/dl) above the upper limit of normal; skeletal involvement including a fracture or bone mineral density (BMD) by T-score ≤ −2.5 at any site; renal involvement including reduced renal function, nephrocalcinosis, nephrolithiasis or significant hypercalciuria. Surgery for PHPT should be carried out by surgeons who frequently perform parathyroidectomy. Surgical success is further enhanced by preoperative localisation of the abnormal parathyroid tissue carried out at centres experienced in current best localisation modalities. During this session the recently updated guidelines on the evaluation and management of primary hyperparathyroidism will be discussed and recent research which allows for improved selection and preparation of appropriate patients for parathyroidectomy will be considered.Reference

1. Bilezikian et al J Bone Miner Res 2022 Nov;37(11):2293-2314.