Skip to main content
Erschienen in: Wiener Medizinische Wochenschrift 17-18/2013

01.09.2013 | main topic

Clinical aspects of primary hyperparathyroidism: clinical manifestations, diagnosis, and therapy

verfasst von: Ao.Univ.-Prof. Dr. Rudolf Wolfgang Gasser

Erschienen in: Wiener Medizinische Wochenschrift | Ausgabe 17-18/2013

Einloggen, um Zugang zu erhalten

Summary

Primary hyperparathyroidism (PHPT) is the most common cause of hypercalcemia. An autonomous overproduction of parathyroid hormone leading to hypercalcemia, which is not downregulated by the calcium-sensing receptor, is the pathophysiological basis of the disease. The classical manifestations of PHPT include a generalized bone disease, kidney stones, and nephrocalcinosis, gastrointestinal, cardiovascular, neuromuscular and neuropsychiatric symptoms. Recently, the clinical presentation of PHPT, however, has changed in Western countries, it occurs oligo-asymptomatic in up to 80 %. Clinical examination, laboratory, and imaging techniques for the characterization of the disease and the localization include the diagnostic procedure. If possible, parathyroidectomy is the treatment of choice for clinically overt PHPT, for asymptomatic PHPT guidelines were developed in order to decide in individual cases between surgical and conservative approach; this consists of monitoring, adequate calcium and vitamin D intake, as well as hydration. Medical therapy includes bisphosphonates and calcimimetics.
Literatur
1.
Zurück zum Zitat Wermers RA, Khosla S, Atkinson EJ, et al. Incidence of primary hyperparathyroidism in Rochester, Minnesota, 1993–2001: an update on the changing epidemiology of the disease. J Bone Min Res. 2006;21:171–7.CrossRef Wermers RA, Khosla S, Atkinson EJ, et al. Incidence of primary hyperparathyroidism in Rochester, Minnesota, 1993–2001: an update on the changing epidemiology of the disease. J Bone Min Res. 2006;21:171–7.CrossRef
2.
Zurück zum Zitat Pallan S, Rahman MO, Khan AA. Diagnosis and management of primary hyperparathyroidism. BMJ. 2012;344:e1013. doi: 10.1136/bmj.e1013.PubMedCrossRef Pallan S, Rahman MO, Khan AA. Diagnosis and management of primary hyperparathyroidism. BMJ. 2012;344:e1013. doi: 10.1136/bmj.e1013.PubMedCrossRef
3.
4.
Zurück zum Zitat El-Hajj Fuleihan G, Silverberg SJ. Clinical manifestations of primary hyperparathyroidism. UpToDate 2012. El-Hajj Fuleihan G, Silverberg SJ. Clinical manifestations of primary hyperparathyroidism. UpToDate 2012.
5.
Zurück zum Zitat Bilezikian JP, Silverberg SJ. Clinical practice. Asymptomatic primary hyperparathyroidism. N Engl J Med. 2004;350:1746.PubMedCrossRef Bilezikian JP, Silverberg SJ. Clinical practice. Asymptomatic primary hyperparathyroidism. N Engl J Med. 2004;350:1746.PubMedCrossRef
6.
Zurück zum Zitat Silverberg SJ, Lewiecki EM, Mosekilde L, et al. Presentation of asymptomatic primary hyperparathyroidism: proceedings of the third international workshop. J Clin Endocrinol Metab. 2009;94:351–65. Silverberg SJ, Lewiecki EM, Mosekilde L, et al. Presentation of asymptomatic primary hyperparathyroidism: proceedings of the third international workshop. J Clin Endocrinol Metab. 2009;94:351–65.
7.
Zurück zum Zitat Kerschan-Schindl K. Bone turnover in hyperparathyroidism. Wien Med Wochenschr. 2012. DOI 10.1007/s10354-012-0125-9. Kerschan-Schindl K. Bone turnover in hyperparathyroidism. Wien Med Wochenschr. 2012. DOI 10.1007/s10354-012-0125-9.
8.
Zurück zum Zitat Chen Q, Kaji H, Iu MF, et al. Effects of an excess and a deficiency of endogenous parathyroid hormone on volumetric bone mineral density and bone geometry determined by peripheral quantitative computed tomography in female subjects. J Clin Endocrinol Metab. 2003;88:4655–8.PubMedCrossRef Chen Q, Kaji H, Iu MF, et al. Effects of an excess and a deficiency of endogenous parathyroid hormone on volumetric bone mineral density and bone geometry determined by peripheral quantitative computed tomography in female subjects. J Clin Endocrinol Metab. 2003;88:4655–8.PubMedCrossRef
9.
Zurück zum Zitat Sun JM, Cronan JJ, Monchik JM. Primary hyperparathyroidism: is there an increased prevalence in renal stone disease? Am J Roentgenol. 2008;191:908–11.CrossRef Sun JM, Cronan JJ, Monchik JM. Primary hyperparathyroidism: is there an increased prevalence in renal stone disease? Am J Roentgenol. 2008;191:908–11.CrossRef
10.
Zurück zum Zitat Cheung K, Wang TS, Farrokhyar F, et al. A meta-analysis of preoperative localization techniques for patients with primary hyperparathyroidism. Ann Surg Oncol. 2012;19:577–83.PubMedCrossRef Cheung K, Wang TS, Farrokhyar F, et al. A meta-analysis of preoperative localization techniques for patients with primary hyperparathyroidism. Ann Surg Oncol. 2012;19:577–83.PubMedCrossRef
11.
Zurück zum Zitat Yip L, Silverberg SJ, El-Hajj Fuleihan G. Preoperative localization for parathyroid surgery in patients with primary hyperparathyroidism. UpToDate 2013. Yip L, Silverberg SJ, El-Hajj Fuleihan G. Preoperative localization for parathyroid surgery in patients with primary hyperparathyroidism. UpToDate 2013.
12.
Zurück zum Zitat Prommegger R, Wimmer G, Profanter C, et al. Virtual neck exploration: a new method for localizing abnormal parathyroid glands. Ann Surg. 2009;250:761–5.PubMedCrossRef Prommegger R, Wimmer G, Profanter C, et al. Virtual neck exploration: a new method for localizing abnormal parathyroid glands. Ann Surg. 2009;250:761–5.PubMedCrossRef
13.
Zurück zum Zitat Wimmer G, Profanter C, Kovacs P, et al. CT-MIBI-SPECT image fusion predicts multiglandular disease in hyperparathyroidism. Langenbecks Arch Surg. 2010;395:73–80.PubMedCrossRef Wimmer G, Profanter C, Kovacs P, et al. CT-MIBI-SPECT image fusion predicts multiglandular disease in hyperparathyroidism. Langenbecks Arch Surg. 2010;395:73–80.PubMedCrossRef
14.
Zurück zum Zitat Udelsman R, Pasieka J, Sturgeon C, et al. Surgery for asymptomatic primary hyperparathyroidism. J Clin Endocrinol Metab. 2009;94:366–72.PubMedCrossRef Udelsman R, Pasieka J, Sturgeon C, et al. Surgery for asymptomatic primary hyperparathyroidism. J Clin Endocrinol Metab. 2009;94:366–72.PubMedCrossRef
15.
Zurück zum Zitat Bilezikian JP, Khan AA, Potts JT, et al. Guidelines for the management of asymptomatic primary hyperparathyroidism: summary statement from the third international workshop. J Clin Endocrinol Metab. 2009;94:335–9.PubMedCrossRef Bilezikian JP, Khan AA, Potts JT, et al. Guidelines for the management of asymptomatic primary hyperparathyroidism: summary statement from the third international workshop. J Clin Endocrinol Metab. 2009;94:335–9.PubMedCrossRef
16.
Zurück zum Zitat Perrier ND, Dickson PV. Parathyroid exploration for primary hyperparathyroidism. UpToDate 2013. Perrier ND, Dickson PV. Parathyroid exploration for primary hyperparathyroidism. UpToDate 2013.
17.
Zurück zum Zitat Witteveen J, van Thiel S, Romijn JA, et al. Hungry bone syndrome: still a challenge in the post-operative management of primary hyperparathyroidism. A systemic review of the literature. Eur J Endocrinol. 2013;168:R45–53. Witteveen J, van Thiel S, Romijn JA, et al. Hungry bone syndrome: still a challenge in the post-operative management of primary hyperparathyroidism. A systemic review of the literature. Eur J Endocrinol. 2013;168:R45–53.
18.
Zurück zum Zitat Silverberg SJ, El-Hajj Fuleihan G. Management of primary hyperparathyroidism. UpToDate 2013. Silverberg SJ, El-Hajj Fuleihan G. Management of primary hyperparathyroidism. UpToDate 2013.
19.
Zurück zum Zitat Peacock M, Bilezikian JP, Bolognese MA, et al. Cinacalcet HCl reduces hypercalcemia in primary hyperparathyroidism across a wide spectrum of disease severity. J Clin Endocrinol Metab. 2011;96:E9–18.PubMedCrossRef Peacock M, Bilezikian JP, Bolognese MA, et al. Cinacalcet HCl reduces hypercalcemia in primary hyperparathyroidism across a wide spectrum of disease severity. J Clin Endocrinol Metab. 2011;96:E9–18.PubMedCrossRef
20.
Zurück zum Zitat Rubin MR, Lee KH, McMahon DJ, et al. Raloxifene lowers serum calcium and markers of bone turnover in postmenopausal women with primary hyperparathyroidism. J Clin Endocrinol Metab. 2003;88:1174–8.PubMedCrossRef Rubin MR, Lee KH, McMahon DJ, et al. Raloxifene lowers serum calcium and markers of bone turnover in postmenopausal women with primary hyperparathyroidism. J Clin Endocrinol Metab. 2003;88:1174–8.PubMedCrossRef
Metadaten
Titel
Clinical aspects of primary hyperparathyroidism: clinical manifestations, diagnosis, and therapy
verfasst von
Ao.Univ.-Prof. Dr. Rudolf Wolfgang Gasser
Publikationsdatum
01.09.2013
Verlag
Springer Vienna
Erschienen in
Wiener Medizinische Wochenschrift / Ausgabe 17-18/2013
Print ISSN: 0043-5341
Elektronische ISSN: 1563-258X
DOI
https://doi.org/10.1007/s10354-013-0235-z

Weitere Artikel der Ausgabe 17-18/2013

Wiener Medizinische Wochenschrift 17-18/2013 Zur Ausgabe