Diagnosis, natural history, and treatment of primary hyperparathyroidism.

Abstract

Primary hyperparathyroidism, one of the most common endocrine disorders, is characterized by hypercalcemia in the presence of elevated parathyroid hormone levels. The disease today bears little resemblance to the severe disorder of ‘stones, bones and groans’ described by Fuller Albright and others in the 1930s [1–6]. Osteitis fibrosa cystica was the hallmark of classic primary hyperparathyroidism. This skeletal condition was characterized by brown tumors of the long bones, subperiosteal bone resorption, distal tapering of the clavicles and phalanges, and a‘salt and pepper’ appearance of the skull on radiograph [7]. Nephrocalcinosis was present in 80% of patients, and neuromuscular dysfunction with muscle weakness was common. With the advent of the automated serum chemistry autoanalyzer in the 1970s, diagnosis of primary hyperparathyroidism became commonplace in the complete absence of symptoms [8–10].