ABSTRACT
This chapter focuses on the management of primary hyperparathyroidism (PHPT). Because secondary hyperparathyroidism (SHPT) has underlying medical causes, management of the range of conditions causing SHPT is beyond the scope of the chapter. Hyperparathyroidism literally means excess secretion of parathyroid hormone (PTH). Parathyroidectomy is the only curative treatment for PHPT, with first-time cure rates exceeding 95% of cases. Parathyroidectomy is the only cure for PHPT and should be recommended in all patients with symptomatic PHPT or evidence of end-organ damage such as low bone mineral density (BMD) or kidney stones. A number of randomized controlled trials of parathyroidectomy versus observation in patients with asymptomatic PHPT have demonstrated improvements in BMD, neurocognitive function and quality of life. Some clinicians believe 'asymptomatic' patients with no complications can be managed non-surgically, while others believe virtually all patients with biochemical evidence of PHPT should undergo parathyroidectomy as there may be 'insidious' elements to chronic mild PHPT.
