Management of parathyroid disease

Abstract

Primary hyperparathyroidism is a common endocrine disorder caused by excessive parathyroid hormone (PTH) production by one or more parathyroid glands causing raised serum calcium levels. The diagnosis is made via biochemistry. Surgery is the only definitive treatment and all patients with symptomatic disease or evidence of end-organ damage should be offered surgery if possible. Imaging studies are used to plan the surgical strategy. Most patients with primary hyperparathyroidism have a single parathyroid adenoma. Positive imaging studies allow patients to undergo minimally invasive surgery. Negative imaging does not rule out surgery and patients should be offered a traditional 4 gland bilateral neck exploration. Secondary hyperparathyroidism is commonly caused by renal failure. Medical management is the first line treatment, followed by parathyroidectomy in selected cases. Tertiary hyperparathyroidism is seen in patients with continued autonomous function of the parathyroid glands after removal of the underlying stimulus. It is commonly seen in renal transplant patients and parathyroidectomy has a role.