Hyperparathyroïdie primaire : nouveaux concepts, nouvelles recommandations

摘要: Today, primary hyperparathyroidism (PHPT) is frequently diagnosed at an asymptomatic stage. New international guidelines presented the Endocrine Society congress update management of this disease. Normocalcemic PHPT part diagnostic spectrum PHPT, its natural history poorly known, and monitoring proposed once secondary HPT has been eliminated. Bone involvement, classically predominant in cortical bone, also affects trabecular bone. Osteodensitometry effective vertebral level new methods (trabecular bone score [TBS], fracture assessment [VFA]) should improve risk fracture. The kidney most symptomatic organ, imaging workup as well urinary tests are recommended all patients when searching for causes lithiasis or nephrocalcinosis. More than 10% cases related to a germinal mutation: these be identified optimize their that relatives. Medical treatment reserved whom surgery not indicated possible: cinacalcet calcemia, bisphosphonates involvement. Vitamin D deficiency can corrected long calcemia creatinuria monitored. Surgical case pronounced hypercalcemia, renal age less 50 years refused impossible. Studies have shown evolves little monitored patients.