2018•Primer on the metabolic bone diseases and disorders of mineral metabolismRequires access
Primary Hyperparathyroidism
Shonni J. Silverberg, Francisco Alfredo Farias Bandeira, Jianmin Liu, Claudio Marcocci, Marcella Donovan Walker
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Abstract
The pathophysiology of primary hyperparathyroidism (PHPT) relates to the loss of normal control of PTH synthesis and secretion. The etiology of PHPT is apparent in only a small minority of patients. The molecular basis for PHPT remains elusive in the vast majority of patients. “Classical” PHPT was a symptomatic disease associated with a typical skeletal disorder, nephrolithiasis, and neuromuscular complaints. The most common clinical presentation of PHPT is characterized by mild asymptomatic hypercalcemia, often discovered on a routine multichannel screening test. Rarely, a patient will present with life-threatening hypercalcemia, so-called acute PHPT, or parathyroid crisis. The diagnosis of PHPT is instead established by laboratory tests. Surgery provides the only option for cure of PHPT. The presentation of PHPT differs in various geographic locales, and in many countries asymptomatic PHPT is not the prevailing form of the disease.