Management and Assessment of Primary Hyperparathyroidism
Summary
Primary hyperparathyroidism is characterised by autonomous secretion of parathyroid hormone, leading to hypercalcaemia and its sequelae in bone, renal and cardiovascular systems. Contemporary assessment relies on biochemical profiling of serum calcium, phosphate and parathyroid hormone, supplemented by measurement of vitamin D status and renal function. Imaging with neck ultrasonography and sestamibi scintigraphy facilitates localisation of adenomas, while dual-energy X-ray absorptiometry quantifies skeletal involvement. Management decisions are guided by stratified criteria that consider symptomatology, calcium levels, bone density, renal stones and patient age. Surgical excision remains the definitive therapy for eligible patients, with minimally invasive approaches increasingly replacing four-gland exploration. In those unfit for surgery, medical strategies comprise calcimimetics, antiresorptive agents and vigilant surveillance. Attention to non-classical manifestations such as neurocognitive changes and cardiovascular risk factors has expanded the therapeutic remit, prompting revised guidelines that balance intervention against conservative follow-up. Globally, variations in screening practices and resource availability influence presentation and outcomes, underscoring the need for tailored pathways that integrate emerging biomarkers and imaging modalities.
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Management and Assessment of Primary Hyperparathyroidism publication trend
The graph below shows the total number of articles in management and assessment of primary hyperparathyroidism across all publications each year (not limited to Nature Index journals).
Technical terms
Primary hyperparathyroidism: A disorder of excessive parathyroid hormone secretion causing hypercalcaemia.
Parathyroid hormone (PTH): A peptide hormone secreted by the parathyroid glands that regulates calcium and phosphate homeostasis.
Parathyroidectomy: Surgical removal of one or more parathyroid glands to normalise PTH levels and calcium balance.
Normocalcaemic primary hyperparathyroidism: A variant characterised by elevated PTH with persistently normal serum calcium.
Calcium-sensing receptor (CaSR): A G-protein-coupled receptor on parathyroid cells that modulates PTH release in response to extracellular calcium levels.
References
- Investigating the risk of metabolic and cardiovascular comorbidities among patients with parathyroid cancer: a nationwide representative cohort study in Taiwan. BMC Medicine (2023).
- Epidemiology, Pathophysiology, and Genetics of Primary Hyperparathyroidism. Journal of Bone and Mineral Research (2020).
- Normocalcemic Hyperparathyroidism: Study of its Prevalence and Natural History. The Journal of Clinical Endocrinology & Metabolism (2020).
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