Mild primary hyperparathyroidism-to treat or not to treat?

Hassan-Smith, Zaki K and Criseno, Sherwin and Gittoes, Neil J L (2019) Mild primary hyperparathyroidism-to treat or not to treat? British medical bulletin, 129 (1). pp. 53-67. ISSN 1471-8391. This article is available to all UHB staff and students via ASK Discovery tool http://tinyurl.com/z795c8c by using their UHB Athens login IDs

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Abstract

INTRODUCTION

The presentation of primary hyperparathyroidism (PHPT) has shifted from a disease characterized by renal and skeletal complications to a mild or asymptomatic condition. Modern imaging allows localization of a surgical target in the majority of cases.

SOURCES OF DATA

Data were collected from literature searches of online databases including PUBMED, MEDLINE and Cochrane. A narrative review was performed.

AREAS OF AGREEMENT

Parathyroidectomy is the only therapy with curative potential with good outcomes and low risk of complications in experienced hands. Current guidelines advocate that surgery is offered in all symptomatic cases and in those who meet criteria depending on age, serum calcium concentration, skeletal and renal parameters. A structured monitoring approach should be offered to those who do not undergo surgery.

AREAS OF CONTROVERSY

Thresholds for intervention to improve skeletal and renal outcomes are debatable. In addition, controversy persists over the benefit of surgery for non-skeletal/renal outcomes.

GROWING POINTS

The role of medical management of PHPT using agents such as bisphosphonates, denosumab and cinacalcet are discussed.

AREAS TIMELY FOR DEVELOPING RESEARCH

In summary, further data on the natural history and effects of treatment of mild and asymptomatic PHPT are required to determine thresholds for surgery. In particular, further investigations of non-skeletal and non-renal parameters, such as neurocognitive quality of life and cardiovascular disease are required. Data on normocalcaemic PHPT are lacking. Large-scale randomized controlled trials would be welcome in these areas, however in view of the cost implications a more pragmatic approach may be to develop collaborative multi-centre registries.

Item Type: Article
Additional Information: This article is available to all UHB staff and students via ASK Discovery tool http://tinyurl.com/z795c8c by using their UHB Athens login IDs
Subjects: WK Endocrine system. Endocrinology
Divisions: Clinical Support > Pathology
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Depositing User: Mr Philip O'Reilly
Date Deposited: 16 Aug 2019 14:09
Last Modified: 16 Aug 2019 14:09
URI: http://www.repository.uhblibrary.co.uk/id/eprint/2308

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