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Endocrinology and Diabetes pp 279–291Cite as

Primary Hyperparathyroidism

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Abstract

Primary hyperparathyroidism (PHPT) is a disorder caused by hypersecretion of one or more parathyroid glands with consequent hypercalcemia (Bilezikian et al., J Intern Med 257:6–17, 2005). In about 90 % of cases, patients present with either normal or slightly increased serum PTH levels, which in both cases are inappropriately high in the presence of hypercalcemia (Bandeira et al., Endocrinologia e Diabetes, Medbook, 2ªed, 37:385–393, 2009).

Overall, there are different clinical presentations of the disease. The asymptomatic hypercalcemic type is the one most frequently found (80 %), and an early diagnosis prevents the progression of the disorder to the classical clinical picture that is more severe (Bandeira et al., Bone 23(suppl):S380, 1998). However, the clinical presentation may be atypical and includes disorders of the calcium homeostasis, ranging from severe hypercalcemia to normocalcemic PHPT (Bilezikian et al., J Intern Med 257:6–17, 2005; Mundy et al., Lancet 1:1317–1320, 1980).

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References

  1. Eufrazino CSS, Veras A, Bandeira F. Prevalência de hiperparatireoidismo primário em uma grande população atendida em dois centros de referência na cidade do Recife. Arq Bras Endocrinol Metabol. 2010; 54:S439.

    Google Scholar 

  2. Bandeira F, Griz L, Caldas G, et al. Characteristics of primary hyperparathyroidism in one institution in northeast Brazil. Bone. 1998;23(suppl):S380.

    Google Scholar 

  3. Rodgers SE, Lew JI, Solórzano CC. Primary hyperparathyroidism. Curr Opin Oncol. 2008;20:52–8.

    Article  PubMed  Google Scholar 

  4. Bilezikian JP, Brandi ML, Rubin M, Silverberg SJ. Primary hyperparathyroidism: new concepts in clinical, densitometric and biochemical features. J Intern Med. 2005;257:6–17.

    Article  PubMed  CAS  Google Scholar 

  5. Brandi ML, Falchetti A. Genetics of primary hyperparathyroidism. Urol Int. 2004; 72 (Suppl 1):11–6)

    Google Scholar 

  6. Simonds WF, James-Newton LA, Agarwal SK, et al. Familial isolated hyperparathyroidism: clinical and genetic characteristics of thirty-six kindreds. Medicine (Baltimore). 2002;81:1–26.

    Article  Google Scholar 

  7. Marx SJ, Simonds SF, Agarwal SK, et al. Hyperparathyroidism in hereditary syndromes: special expressions and special managements. J Bone Miner Res. 2002;17:37–43.

    Google Scholar 

  8. Eastell R, Arnold A, Brandi ML, et al. Diagnosis of asymtomatic primary hyperparathyroidism: proceedings of the third international workshop. J Clin Endocrinol Metab. 2009;94:340–50.

    Article  PubMed  CAS  Google Scholar 

  9. Andrade LD, Marques TF, Diniz ET, Lucena CS, Griz L, Banderia F. Impact of the use of hydrochlorothiazide in secretion PTH in hypertensive patients. Arq Bras Endocrinol Metabol. 2010;54 Suppl 5:S491.

    Google Scholar 

  10. Jacobs TP, Bilezikian JP. Clinical review: rare causes of hypercalcemia. J Clin Endocrinol Metab. 2005;90:66316–22.

    Article  Google Scholar 

  11. Pausova Z, Soliman E, Amizuka N, Janicic N, Konrad EM, Arnold A, et al. Role of the RET proto-oncogene in sporadic hyperparathyroidism and in hyperparathyroidism of multiple endocrine neoplasia type 2. J Clin Endocrinol Metab. 1996;81(7):2711.

    Article  PubMed  CAS  Google Scholar 

  12. Feder JM, Sirrs S, Anderson D, Sharif J, Khan A. Primary hyperparathyroidism: an overview. Intern J of Endocrinol. 2011;2011:251410.

    Google Scholar 

  13. Ong GSY, Walsh JP, Stuckey BGA, Brown SJ, Rossi E, Ng JL, et al. The importance of measuring ionized calcium in characterizing calcium status and diagnosing primary hyperparathyroidism. J Clin Endocrinol Metab. 2012;97(9):3138–45.

    Article  PubMed  CAS  Google Scholar 

  14. Yu N, Donnan PT, Murphy MJ, Leese GP. Epidemiology of primary hyperparathyroidism in Tayside, Scotland, UK. Clin Endocrinol. 2009;71:485–93.

    Article  Google Scholar 

  15. Bandeira F, Caldas G, Freese E, Griz L, Faria M, Bandeira C. Relationship between vitamin D serum status and clinical manifestations of primary hyperparathyroidism. Endocr Pract. 2002;8:266–70.

    Article  PubMed  Google Scholar 

  16. Bandeira FB, Griz L, Caldas G, Bandeira C, Freese E. From mild to severe primary hyperparathyroidism: the Brazilian experience. Arq Bras Endocrinol Metabol. 2006;50(4):657–63.

    Article  PubMed  Google Scholar 

  17. Bandeira F, Graf H, Griz L, Faria M, Lazaretti-Castro M. Endocrinologia e diabetes, vol. 37. 2ªth ed. Rio de Janeiro: Medbook; 2009. p. 385–93.

    Google Scholar 

  18. Carroll MF, Schade DS. A practical approach to hypercalcemia. Am Fam Physician. 2003;67:1959–66.

    PubMed  Google Scholar 

  19. Bilezikian JP, Silverberg SJ. Normocalcemic primary hyperparathyroidism. Arq Bras Endocrinol Metabol. 2010;54(2):106–9.

    Article  PubMed  Google Scholar 

  20. Guise TA, Mundy GR. Cancer and bone. Endocr Rev. 1998;19(1):18–54.

    Article  PubMed  CAS  Google Scholar 

  21. Silverberg SJ, Lewiecki EM, Mosekilde L, et al. Presentation of asymptomatic primary hyperparathyroidism: proceedings of the third international workshop. J Clin Endocrinol Metab. 2009;94:351–65.

    Article  PubMed  CAS  Google Scholar 

  22. Silverberg SJ, Bilezikian JP. Primary hyperparathyroidism. Endocrinology. 2001;1075–93.

    Google Scholar 

  23. Lowe H, McMahon DJ, Rubin MR, Bilezikian JP, Silverberg SJ. Normocalcemic primary hyperparathyroidism: further characterization of a new clinical phenotype. J Clin Endocrinol Metab. 2007;92:3001–5.

    Article  PubMed  CAS  Google Scholar 

  24. Marques TF, Vasconcelos R, Diniz E, Rêgo D, Griz L, Bandeira F. Normocalcemic primary hyperparathyroidism in clinical practice: an indolent condition or a silent threat? Arq Bras Endocrinol Metabol. 2011;55(5):314–7.

    Article  PubMed  Google Scholar 

  25. Tordjman KM, Greenman Y, Osher E, Shenkerman G, Sern N. Characterization of normocalcemic primary hyperparathyroidism. Am J Med. 2004;117:861–3.

    Article  PubMed  Google Scholar 

  26. Lundgren E, Hagstrom EG, Lundin J, Winnerback MB, Roos J, Ljunghall S, et al. Primary hyperparathyroidism revisited in menopausal women with serum calcium in the upper normal range at population based screening 8 yrs ago. World J Surg. 2002;26:931–6.

    Article  PubMed  Google Scholar 

  27. Silverberg SJ, Bilezikian JP. “Incipient” primary hyperparathyroidism: a “forme fruste” of an old disease. J Clin Endocrinol Metab. 2003;88(11):5348–52.

    Article  PubMed  CAS  Google Scholar 

  28. Bilezikian JP, Rubin M, Silverberg SJ. Asymptomatic primary hyperparathyroidism. Arq Bras Endocrinol Metabol. 2006;50(4):647–56.

    Article  PubMed  Google Scholar 

  29. Siilin H, Lundgren E, Mallmin H, et al. Prevalence of primary hyperparathyroidism and impact on bone mineral density in elderly men: MrOs Sweden. World J Surg. 2011;35(6):1266–72.

    Article  PubMed  Google Scholar 

  30. Rao DS, Philips ER, Divind GW, Talpos GB. Randomized controlled clinical trial of surgery versus no surgery in patients with mild PHPT. J Clin Endocrinol Metab. 2004;89:5415–22.

    Article  PubMed  CAS  Google Scholar 

  31. Tamura Y, Araki A, Chiba Y, Mori S, Hosoi T, Horiuchi T. Remarkable increase in lumbar spine bone mineral density and amelioration in biochemical markers of bone turnover after parathyroidectomy in elderly patients with primary hyperparathyroidism: a 5-year follow-up study. J Bone Miner Metab. 2007;25:226–31.

    Article  PubMed  Google Scholar 

  32. Joborn C, Hetta J, Johansson H, et al. Psychiatric morbidity in primary hyperparathyroidism. World J Surg. 1988;12:476–81.

    Article  PubMed  CAS  Google Scholar 

  33. Coker LH, Rorie K, Cantley L, Kirkland K, Stump D, Burbank N, et al. Primary hyperparathyroidism, cognition, and health-related quality of life. Ann Surg. 2005;242(5):642–50.

    Article  PubMed  Google Scholar 

  34. Walker MD, McMahon DJ, Inabnet WB, Lazar RM, Brown I, Vardy S, et al. Neuropsychological features in primary hyperparathyroidism: a prospective study. J Clin Endocrinol Metab. 2009;94(6):1951–8.

    Article  PubMed  CAS  Google Scholar 

  35. Eufrazino CSS, Bandeira F, et al. Peripheral polyneuropathy associated with primary hyperparathyroidism. Arq Bras Endocrinol Metabol. 2008;52(6):976.

    Google Scholar 

  36. Moskal W. Severe sensorimotor polyneuropathy in primary hyperparathyroidism. Neurol Neurochir Pol. 1999;33(6):1443–7.

    PubMed  CAS  Google Scholar 

  37. Chou FF, Sheen-Chen SM, Leong CP. Neuromuscular recovery after parathyroidectomy in primary hyperparathyroidism. Surgery. 1995;117(1):18–25.

    Article  PubMed  CAS  Google Scholar 

  38. Hedback M, Odén S, et al. Cardiovascular disease, hypertension and renal function in primary hyperparathyroidism. J Intern Med. 2002;251:476–83.

    Article  PubMed  CAS  Google Scholar 

  39. Marcocci C, Cetani F. Primary hyperparathyroidism. N Engl J Med. 2011;365:2389–97.

    Article  PubMed  CAS  Google Scholar 

  40. Yu N, Donnan PT, Flynnt RWV, et al. Increased mortality and morbidity in mild primary hyperparathyroid patients. The parathyroid epidemiology and audit research study (PEARS). Clin Endocrinol. 2010; 73:30–4.

    Google Scholar 

  41. Yu N, Donnan PT, Leeset GP. A record linkage study of outcomes in patients with mild primary hyperparathyroidism: the parathyroid epidemiology and audit research study (PEARS). Clin Endocrinol. 2011;75:160–76.

    Article  Google Scholar 

  42. Amaral LMB, Queiroz DC, Marques TF, Mendes M, Bandeira F. Normocalcemic versus hypercalcemic primary hyperparathyroidism: more stone than bone? J Osteoporos. 2012;2012:128352.

    PubMed  CAS  Google Scholar 

  43. Udelsman R, Pasieka JL, et al. Surgery for asymptomatic primary hyperparathyroidism: proceedings of the third international workshop. J Clin Endocrinol Metab. 2009;94:366–72.

    Article  PubMed  CAS  Google Scholar 

  44. Mohammadi A, Moloudi F, Ghasemi-rad M. The role of colour Doppler ultrasonography in the preoperative localization of parathyroid adenomas. Endocr J. 2012;59(5):375–82.

    Article  PubMed  Google Scholar 

  45. Bandeira FAF, Oliveira R, Griz L, Caldas G, Bandeira C. Differences in accuracy of TC 99m – Sestamibi scanning between severe and mild forms of primary hyperparathyroidism. J Nucl Med Technol. 2008; 36:30–5.

    Article  PubMed  CAS  Google Scholar 

  46. Beland MD, Mayo-Smith WW, Grand DJ, Machan JT, Monchik JM. Dynamic MDCT for localization of occult parathyroid adenomas in 26 patients with primary hyperparathyroidism. AJR Am J Roentgenol. 2011;196(1):61–5.

    Article  PubMed  Google Scholar 

  47. Chazen JL, Gupta A, Dunning A, Phillps CD. Diagnostic accuracy of 4D-CT for parathyroid adenomas and hyperplasia. AJNR Am J Neuroradiol. 2012;33(3):429–33.

    Article  PubMed  CAS  Google Scholar 

  48. Carvalho JRP, Diniz ET, Marques TF, Lima TPM, Galamba L, Bandeira F. PTH measurement in the fine-needle aspirates from cervical nodules in primary hyperparathyroidism. Endocr Rev. 2011;32:P1–251.

    Article  Google Scholar 

  49. Bilezikian JP, Khan AA, Potts JT. Guidelines for the management of asymptomatic primary hyperparathyroidism: summary statement from the third international workshop. J Clin Endocrinol Metab. 2009;94:335–9.

    Article  PubMed  CAS  Google Scholar 

  50. Rubin MR, Bilezikian JP, McMahon DJ, Jacobs T, Shane E, Siris E, et al. The natural history of primary hyperparathyroidism with or without parathyroid surgery after 15 years. J Clin Endocrinol Metab. 2008;93:3462–70.

    Article  PubMed  CAS  Google Scholar 

  51. Bollerslev J, Jansson S, Mollerup CL, Nordenström J, Lundgren E, Tørring O, et al. Medical observation, compared with parathyroidectomy, for asymptomatic primary hyperparathyroidism: a prospective, randomized trial. J Clin Endocrinol Metab. 2007;92(5):1687.

    Article  PubMed  CAS  Google Scholar 

  52. Zanocco K, Heller M, Sturgeon C. Cost-effectiveness of parathyroidectomy for primary hyperparathyroidism. Endocr Pract. 2011;17(1):69–74.

    Article  PubMed  Google Scholar 

  53. Slepavicius A, Beisa V, Janusonis V, Strupas K. Focused versus conventional parathyroidectomy for primary hyperparathyroidism: a prospective, randomized, blinded trial. Langenbecks Arch Surg. 2008;393(5):659–66.

    Article  PubMed  Google Scholar 

  54. Clerici T, Brandle M, Lange J, Doherty GM, Gauger PG. Impact of intraoperative parathyroid hormone monitoring on the prediction of multiglandular parathyroid disease. World J Surg. 2004;28(2):187–92.

    Article  PubMed  Google Scholar 

  55. Barczynski M, Konturek A, Cichon S, Hubalewska-Dydejczyk A, Golkowski F, et al. Intraoperative parathyroid hormone assay improves outcomes of minimally invasive parathyroidectomy mainly in patients with a presumed solitary parathyroid adenoma and missing concordance of preoperative imaging. Clin Endocrinol (Oxf). 2007;66(6):878–85.

    Article  CAS  Google Scholar 

  56. Hwang RS, Morris LF, Ro K, Park S, Ituarte PH, Hong JC, et al. A selective, Bayesian approach to intraoperative PTH monitoring. Ann Surg. 2010;251(6):1122–6.

    Article  PubMed  Google Scholar 

  57. Bergenfelz AO, Jansson SK, Wallin GK, Mårtensson HG, Rasmussen L, Eriksson HL, et al. Impact of modern techniques on short-term outcome after surgery for primary hyperparathyroidism: a multicenter study comprising 2,708 patients. Langenbecks Arch Surg. 2009;394(5):851–60.

    Article  PubMed  Google Scholar 

  58. Miccoli P, Berti P, Materazzi G, Ambrosini CE, Fregoli L, Donatini G. Endoscopic bilateral neck exploration versus quick intraoperative parathormone assay (qPTHa) during endoscopic parathyroidectomy: a prospective randomized trial. Surg Endosc. 2008;22: 398–400.

    Article  PubMed  CAS  Google Scholar 

  59. Messa P, Alfieri C, Brezzi B. Cinacalcet: pharmacological and clinical aspects. Expert Opin Drug Metab Toxicol. 2008;4(12):1551–60.

    Article  PubMed  CAS  Google Scholar 

  60. Peacock M, Bilezikian JP, Klasssen PS, et al. Cinacalcet hydrochloride maintains long-term normocalcemia in patients with primary hyperparathyroidism. J Clin Endocrinol Metab. 2005;90(1):135–41.

    Article  PubMed  CAS  Google Scholar 

  61. Peacock M, Bolognese MA, Borofsky M, Scumpia S, Sterling LR, Cheng S. Cinacalcet treatment of primary hyperparathyroidism: biochemical and bone densitometric outcomes in a five-year study. J Clin Endocrinol Metab. 2009;94(12):4860–7.

    Article  PubMed  CAS  Google Scholar 

  62. Rossouw JE, Anderson GL, Prentice RL, LaCroix AZ, Kooperberg C, Stefanick ML, et al. Risks and benefits of estrogen plus progestin in healthy postmenopausal women: principal results from the Women´s Health Initiative randomized controlled trial. JAMA. 2002;288(3):321–33.

    Article  PubMed  CAS  Google Scholar 

  63. Grey AB, Stapleton JP, Evans MC, Tatnell MA, Reid IR. Effect of hormone replacement therapy on bone mineral density in postmenopausal women with mild primary hyperparathyroidism. Ann Intern Med. 1996;125:360–8.

    Article  PubMed  CAS  Google Scholar 

  64. Orr-Walker BJ, Evans MC, Clearwater JM, Horne A, Grey AB, Reid IR. Effect of hormone replacement therapy on bone mineral density in postmenopausal women with primary hyperparathyroidism: four-year follow-up and comparison with healthy postmenopausal women. Arch Intern Med. 2000;160:2161–6.

    Article  PubMed  CAS  Google Scholar 

  65. Rubin MR, Lee KH, McMahon DJ, Silverberg SJ. Raloxifene lowers serum calcium and markers of bone turnover in postmenopausal women with primary hyperparathyroidism. J Clin Endocrinol Metab. 2003;88:1174–8.

    Article  PubMed  CAS  Google Scholar 

  66. Rossini M, Gatti D, Isaia G, Sartori L, Braga V, Adami S. Effect of oral alendronate in elderly patients with osteoporosis and mild primary hyperparathyroidism. J Bone Miner Res. 2001;16:113–9.

    Article  PubMed  CAS  Google Scholar 

  67. Chow CC, Chan WB, Li JK, Chan NN, Chan MH, Ko GT. Oral alendronate increases bone mineral density in postmenopausal women with primary hyperparathyroidism. J Clin Endocrinol Metab. 2003;88: 581–7.

    Article  PubMed  CAS  Google Scholar 

  68. Parker CR, Blackwell PJ, Fairbairn KJ, Hosking DJ. Alendronate in the treatment of primary hyperparathyroid-related osteoporosis: a 2-year study. J Clin Endocrinol Metab. 2002;87:4482–9.

    Article  PubMed  CAS  Google Scholar 

  69. Hershman JM, Hassani S, Braunstein GD, Geola F, Brickman A, Seibel MJ. Bisphosphonate therapy in primary hyperparathyroidism. J Bone Miner Res. 2003;1880:1889.

    Article  Google Scholar 

  70. Khan A, Bilezikian JP, Kung AWC, Ahmed MM, Dubois SJ, HO AY, et al. Alendronate in primary hyperparathyroidism: a double-blind, randomized, placebo-controlled trial. J Clin Endocrinol Metab. 2004;89(7):3319–25.

    Article  PubMed  CAS  Google Scholar 

  71. Jansson S, Morgan E. Biochemical effects from treatment with biphosphonate and surgery in patients with primary hyperparathyroidism. World J Surg. 2004;28: 1293–7.

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Division of Endocrinology and Diabetes, Agamenon Magalhães Hospital, University of Pernambuco Medical School, Desembargador Gois Cavalcante Street, 100, Apto 502, Recife, PE, Brazil

    Francisco Bandeira M.D., Ph.D., Lívia Amaral M.D. & Paula Aragão M.D.

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  1. Francisco Bandeira M.D., Ph.D.
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  2. Lívia Amaral M.D.
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  3. Paula Aragão M.D.
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Correspondence to Lívia Amaral M.D. .

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Editors and Affiliations

  1. Professor Associado e Livre-Docente, Disciplina de Endocrinologia da Faculdade de Ciências Medicas da Universidade de Pernambuco, Chefe da Divisão de Endocrinologia e Diabetes do Hospital Agamenon, Magalhães-MS/UPE, Recife, Brazil

    Francisco Bandeira

  2. American Thyroid Association Past President, American Association of Clinical Endocrinologists, Professor of Medicine, Mayo Clinic College of Medicine President-Elect, Rochester, Minnesota, USA

    Hossein Gharib

  3. Federal Foundation and School of Medical Sciences, Porto Alegre, Brazil

    Airton Golbert

  4. Department of Medicine, University of Pernambuco School of Medicine, Recife, Brazil

    Luiz Griz

  5. Department of Medicine, University of Maranhao School of Medicine, Sao Luis, Brazil

    Manuel Faria

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Bandeira, F., Amaral, L., Aragão, P. (2014). Primary Hyperparathyroidism. In: Bandeira, F., Gharib, H., Golbert, A., Griz, L., Faria, M. (eds) Endocrinology and Diabetes. Springer, New York, NY. https://doi.org/10.1007/978-1-4614-8684-8_22

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