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Presentation of Asymptomatic Primary Hyperparathyroidism: Proceedings of the Third International Workshop

Columbia University College of Physicians & Surgeons (S.J.S., M.R.R.), New York, New York 10032; New Mexico Clinical Research & Osteoporosis Center (E.M.L.), Albuquerque, New Mexico 87106; Department of Endocrinology C (L.M.), Aarhus University Hospital, DK-8000 Aarhus C, Denmark; and Indiana University School of Medicine (M.P.), Indianapolis, Indiana 46202

Address all correspondence and requests for reprints to: Shonni J. Silverberg, M.D., Columbia University College of Physicians and Surgeons, 630 West 168th Street, PH 8W-864, New York, New York 10032. E-mail: sjs5{at}columbia.edu.

Background: At the Third International Workshop on Asymptomatic Primary Hyperparathyroidism (PHPT) in May 2008, recent data on the disease were reviewed. We present the results of a literature review on issues arising from the clinical presentation and natural history of PHPT.

Methods: Questions were developed by the International Task Force on PHPT. A comprehensive literature search for relevant studies was reviewed, and the questions of the International Task Force were addressed by the Consensus Panel.

Conclusions: 1) Data on the extent and nature of cardiovascular involvement in those with mild disease are too limited to provide a complete picture. 2) Patients with mild PHPT have neuropsychological complaints. Although some symptoms may improve with surgery, available data remain inconsistent on their precise nature and reversibility. 3) Surgery leads to long-term gains in spine, hip, and radius bone mineral density (BMD). Because some patients have early disease progression and others lose BMD after 8–10 yr, regular monitoring (serum calcium and three-site BMD) is essential in those followed without surgery. Patients may present with normocalcemic PHPT (normal serum calcium with elevated PTH concentrations; no secondary cause for hyperparathyroidism). Data on the incidence and natural history of this phenotype are limited. 4) In the absence of kidney stones, data do not support the use of marked hypercalciuria (>10 mmol/d or 400 mg/d) as an indication for surgery for patients. 5) Patients with bone density T-score –2.5 or less at the lumbar spine, hip, or distal one third radius should have surgery.

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