How is asymptomatic primary hyperparathyroidism managed?

Updated: Dec 24, 2020
  • Author: Lawrence T Kim, MD, FACS, FACE; Chief Editor: Romesh Khardori, MD, PhD, FACP  more...
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Some clinicians advocate surgical therapy in all patients with primary hyperparathyroidism, modified only for those patients who are not able to tolerate surgery. They argue that the operation is generally well tolerated, that such treatment prevents complications (eg, osteoporosis), and that it may reverse symptoms that patients often do not realize they have (eg, fatigue, mild depression). In addition, the monitoring of asymptomatic patients is expensive and cumbersome. This more liberal approach has been articulated by an expert group convened by the American Association of Clinical Endocrinologists and the American Association of Endocrine Surgeons. They concluded that "...operative management should be considered and recommended for all asymptomatic patients with PHPT [primary hyperparathyroidism] who have a reasonable life expectancy and suitable operative and anesthesia risk factors." [28]  This proactive approach, as with all parathyroidectomies, should depend on the availability of an experienced, well-trained surgeon.  

A survey study by Sharata et al of primary care providers in the United States found that only a minority of respondents showed firm familiarity with management strategies for primary hyperparathyroidism. The investigators found that 31% of the 109 clinicians who responded to the survey were familiar with the whole range of criteria regarding surgical intervention in asymptomatic patients and that 34% were able to accurately identify correct surveillance testing for patients being observed. Among patients under observation, only 16% underwent proper surveillance studies. [29]

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