Abstract
Primary hyperparathyroidism (PHPT) is characterized by the autonomous production of parathyroid hormone (PTH), in which there is hypercalcemia or normal-high serum calcium levels, in the presence of elevated or inappropriately normal serum PTH concentrations. Diagnosis of PHPT is biochemical. Advances in imaging technology, intraoperative parathyroid hormone measurement, and surgical technique now allow parathyroidectomy to be performed using a focused approach without the absolute need of a fourgland exploration. This brief review summarizes the various diagnostic modalities available for successful preoperative localization and management of the modern day PHPT patient. Sri Lanka Journal of Diabetes, Endocrinology and Metabolism 2012; 2 : 101-105 DOI: http://dx.doi.org/10.4038/sjdem.v2i2.4780
Highlights
Primary hyperparathyroidism (PHPT) occurs as a result of increased and uncontrolled secretion of parathyroid hormone because of hyperfunction of one or more parathyroid glands
With increased detection by means of routine calcium screening, the clinical profile of primary hyperparathyroidism in Western countries has shifted from a symptomatic disease, characterized by hypercalcemic symptoms, nephrolithiasis, overt bone disease, and neuromuscular symptoms to one with subtle or no specific symptoms (“asymptomatic” primary hyperparathyroidism) [2,3,4]
In our part of the world where serum calcium is not measured as part of the routine screening, PHPT must always be evaluated in patients with clinical histories of nephrolithiasis, nephrocalcinosis, osseous pain, subperiosteal resorption, and pathologic fractures, as well as in those with age inappropriate osteoporosis-osteopenia on dual-energy Xray absorptiometry (DXA) [6,7]
Summary
Primary hyperparathyroidism (PHPT) occurs as a result of increased and uncontrolled secretion of parathyroid hormone because of hyperfunction of one or more parathyroid glands. With increased detection by means of routine calcium screening, the clinical profile of primary hyperparathyroidism in Western countries has shifted from a symptomatic disease, characterized by hypercalcemic symptoms, nephrolithiasis, overt bone disease, and neuromuscular symptoms to one with subtle or no specific symptoms (“asymptomatic” primary hyperparathyroidism) [2,3,4]. In our part of the world where serum calcium is not measured as part of the routine screening, PHPT must always be evaluated in patients with clinical histories of nephrolithiasis, nephrocalcinosis, osseous pain, subperiosteal resorption, and pathologic fractures, as well as in those with age inappropriate osteoporosis-osteopenia on dual-energy Xray absorptiometry (DXA) [6,7]. Evaluation may be useful in patients with resistant dyspepsia or chronic vague gastrointestinal symptoms
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