Primary hyperparathyroidism: from guidelines to outpatient clinic.

Anda Mihaela Naciu, Gaia Tabacco, Guido Zavatta, Maria P Yavropoulou, Athanasios D Anastasilakis, Polyzois Makras, Andrea Palermo, Pierpaolo Trimboli, Elena Castellano

Journal: Reviews in endocrine & metabolic disorders 2024;25(5):875-896

PMID: 39162944

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Abstract

Primary hyperparathyroidism (PHPT) is a common endocrine disease characterized by hypercalcemia due to inappropriately high parathyroid hormone secretion. While in the typical, symptomatic form of the disease diagnosis is set easily and standard management is surgical removal of the hyperfunctioning parathyroid (HP), this may not be the case in more subtle forms of PHPT, such as the asymptomatic and the normocalcemic PHPT. Localization of the HP could also be challenging, especially in small-sized adenomas, ectopic lesions or multiglandular disease. An experienced surgical team is essential to achieve curative parathyroidectomy. In this article, we used illustrative clinical vignettes to dissect the approach to the patient with PHPT, from the diagnosis establishment to the suggested investigation to identify classical and non-classical PHPT features and the methodology to locate the abnormal tissue. Accordingly, we elaborated on appropriate management, both surgical and conservative.

Address: Unit of Metabolic Bone and Thyroid Disorders, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo 200, Rome, 00128, Italy. [email protected].; Unit of endocrinology and Diabetes, Campus Bio-Medico University, Rome, Italy. [email protected].; Unit of Metabolic Bone and Thyroid Disorders, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo 200, Rome, 00128, Italy.; Unit of endocrinology and Diabetes, Campus Bio-Medico University, Rome, Italy.; Division of Endocrinology and Diabetes Prevention and Care, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy.; Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum University of Bologna, Via Massarenti 9, Bologna, 40138, Italy.; Servizio di Endocrinologia e Diabetologia, Ospedale Regionale di Lugano, Ente Ospedaliero Cantonale (EOC), Lugano, 6900, Switzerland.; Facoltà di Scienze Biomediche, Università della Svizzera Italiana (USI), Lugano, 6900, Switzerland.; Department of Endocrinology, Diabetes and Metabolism, Santa Croce and Carle Hospital, Cuneo, 12100, Italy.; Endocrinology Unit, First Department of Propaedeutic and Internal Medicine, Medical School, National and Kapodistrian University of Athens, Athens, 11527, Greece.; Department of Endocrinology, 424 Military General Hospital, Thessaloniki, Greece.

DOI: 10.1007/s11154-024-09899-5

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https://doi.org/10.1007/s11154-024-09899-5

MeSH Terms: Humans, Hyperparathyroidism, Primary, Ambulatory Care Facilities, Parathyroidectomy, Practice Guidelines as Topic, Female, Male, Middle Aged