Hyperparathyroïdie primitive

Abstract

Primary hyperparathyroidism (PHPT) is due to an inappropriately increased secretion of parathyroid hormone (PTH) by an autonomous parathyroid gland inducing hypercalcemia. It is most often diagnosed after a fortuitous diagnosis of hypercalcemia, or when searching for secondary causes of osteoporosis or renal lithiasis. Clinical presentation depends on patient age, on the degree of hypercalcemia, and/or on the clinical complications concerning mostly bone, kidney, and the cardiovascular system. Most PHPT patients are asymptomatic. The diagnosis of PHPT relies on the biological presentation. The diagnosis is easy when serum calcium and PTH levels are both increased above normal, but may be more difficult when one of these two parameters is normal. In case of normal calcemia, the diagnosis of normocalcemic PHPT is possible but only after exclusion of all the potential causes of secondary hyperparathyroidism. Parathyroid imaging has no diagnosis value for PHPT but may localize the diseased gland(s) and thus help during surgery, and may detect an associated throid disorder. The treatment of choice is parathyroid surgery (parathyroidectomy) but its indication is based on existing complications, or risk of complications. In PHPT patients with no clear indication for parathyroid surgery, checking biological parameters (serum calcium, PTH and creatinine) and bone mineral density regularly is mandatory.