Mild primary hyperparathyroidism-to treat or not to treat?

摘要: INTRODUCTION The presentation of primary hyperparathyroidism (PHPT) has shifted from a disease characterized by renal and skeletal complications to mild or asymptomatic condition. Modern imaging allows localization surgical target in the majority cases. SOURCES OF DATA Data were collected literature searches online databases including PUBMED, MEDLINE Cochrane. A narrative review was performed. AREAS AGREEMENT Parathyroidectomy is only therapy with curative potential good outcomes low risk experienced hands. Current guidelines advocate that surgery offered all symptomatic cases those who meet criteria depending on age, serum calcium concentration, parameters. structured monitoring approach should be do not undergo surgery. CONTROVERSY Thresholds for intervention improve are debatable. In addition, controversy persists over benefit non-skeletal/renal outcomes. GROWING POINTS role medical management PHPT using agents such as bisphosphonates, denosumab cinacalcet discussed. TIMELY FOR DEVELOPING RESEARCH summary, further data natural history effects treatment required determine thresholds particular, investigations non-skeletal non-renal parameters, neurocognitive quality life cardiovascular required. normocalcaemic lacking. Large-scale randomized controlled trials would welcome these areas, however view cost implications more pragmatic may develop collaborative multi-centre registries.