When Is Surgery Indicated for Asymptomatic Primary Hyperparathyroidism?

Background

Over the past 30 years, the industrialized world has observed a shift in the clinical presentation of primary hyperparathyroidism (PHPT). Once a rare symptomatic disorder characterized by kidney stones, bone loss, neuromuscular disorders and other hypercalcemic signs, PHPT is now appreciated to have a much higher incidence than previously thought and to usually be only mildly symptomatic or even asymptomatic. In those patients with symptomatic PHPT, there has never been controversy about the need for surgery and its myriad benefits.

However, the indications for surgery in asymptomatic PHPT did not begin to be defined until the first Consensus Development Conference on the Management of Asymptomatic Primary Hyperparathyroidism, sponsored by the National Institutes of Health, in 1990. A second international conference in 2002, and a third, in May 2008, have further refined consensus guidelines for surgical indications in asymptomatic PHPT. The current guidelines, summarized in this review, are the consensus recommendations of 10 international endocrine societies, including two endocrine surgical societies. This review will summarize the most recent guidelines from the endocrinology literature for surgeons, a group that includes otolaryngologists–head and neck surgeons, who are participating in an increasing share of patient care and research related to parathyroid disease.

Best Practice

Patients with primary hyperparathyroidism, whether they are symptomatic or asymptomatic, benefit from consultation with a parathyroid surgeon, since there are risks and benefits to both operative and non-operative management. The ecumenical consensus guidelines published this year in the endocrinology literature continue to strongly support a role for surgery in most patients with asymptomatic PHPT, in whom end-organ complications of PHPT can be avoided or ameliorated, with an operation that is safe, cost-effective and highly curative in experienced hands. Read the full article in The Laryngoscope.