PRIMARY
HYPERPARATHYROIDISM – MANAGEMENT OPTIONS
SURGERY
Parathyroidectomy
remains the only definitive treatment for primary hyperparathyroidism (PHPT).
It offers immediate and radical cure from the disease. In experienced hands, it
is associated with a very low morbidity. Currently, with the availability of
preoperative localization studies (typically high-resolution neck
ultrasonography and parathyroid scintigraphy [sestamibi scan]), minimally
invasive parathyroidectomy (MIP) is the preferred surgical approach in the
majority of cases. MIP has many advantages over the classical neck exploration
(bilateral approach).
CONSERVATIVE
TREATMENT
Conservative
treatment may be preferred for patients who are poor surgical candidates or
those who refuse surgical treatment. Conservative treatment includes
surveillance, often associated with the use of some medications.
Surveillance
strategy
Every 1
year (annually) - assessment of:
Serum
calcium
Serum
creatinine
Estimated
glomerular filtration rate
Every 1 to
2 years – assessment of:
Bone
mineral density (BMD) with dual-energy X-ray absorptiometry
If
clinically suspected:
Vertebral
fracture assessments
Abdominal
imaging for nephrolithiasis or nephrocalcinosis
Medications
Some
medications have been used for the purposes of normalizing serum calcium levels
(cinacalcet) and urinary calcium excretion (hydrochlorothiazide) or increasing
bone mineral density (BMD) to reduce fracture risk (hormone replacement
therapy, bisphosphonates). However, no single drug has the potential to deliver
the outcomes equal to that of surgical treatment. Biphosphonate treatment
improves BMD but may not actually diminish fracture risk. Cinacalcet decreases
serum calcium and PTH levels, but appears to have no significant beneficial
impact on BMD.
SCNA
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