Nonoperative Management of Mild Primary Hyperparathyroidism: A Reasonable, Evidence-Based Option

EditorialsJune 2022Nonoperative Management of Mild Primary Hyperparathyroidism: A Reasonable, Evidence-Based OptionMark J. Bolland, MBChB, PhD and Andrew Grey, MBChB, MDMark J. Bolland, MBChB, PhDDepartment of Medicine, University of Auckland, Auckland, New ZealandSearch for more papers by this author and Andrew Grey, MBChB, MDDepartment of Medicine, University of Auckland, Auckland, New ZealandSearch for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/M22-0922 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Primary hyperparathyroidism (PHPT) is the most common cause of hypercalcemia, particularly in postmenopausal women, in whom its prevalence is more than 1% (1). Usually, the hypercalcemia is mild and nonprogressive. In countries where biochemistry measurements are common, PHPT is often detected incidentally (1). A solitary parathyroid adenoma is usually the cause, and removal of the affected gland achieves cure. Although a number of guidelines provide advice on who is a candidate for surgical treatment (2), there are few randomized controlled trials to inform recommendations. Instead, expert opinion and observational data are the basis for most guidance. Expert opinion is subject ...References1. Adami S,Marcocci C,Gatti D. Epidemiology of primary hyperparathyroidism in Europe. J Bone Miner Res. 2002;17 Suppl 2:N18-23. [PMID: 12412773] MedlineGoogle Scholar2. Bilezikian JP,Brandi ML,Eastell R, et al. Guidelines for the management of asymptomatic primary hyperparathyroidism: summary statement from the Fourth International Workshop. J Clin Endocrinol Metab. 2014;99:3561-9. [PMID: 25162665] doi:10.1210/jc.2014-1413 CrossrefMedlineGoogle Scholar3. Wentworth K,Shoback D. Applying the guidelines for primary hyperparathyroidism: the path not taken. JAMA Intern Med. 2019;179:1227-9. [PMID: 31305872] doi:10.1001/jamainternmed.2019.1738 CrossrefMedlineGoogle Scholar4. Pretorius M, Lundstam K, Heck A, et al. Mortality and morbidity in mild primary hyperparathyroidism: results from a 10-year prospective randomized controlled trial of parathyroidectomy versus observation. Ann Intern Med. 2022;175:812-19. doi:10.7326/M21-4416 LinkGoogle Scholar5. Bollerslev J,Jansson S,Mollerup CL, et al. Medical observation, compared with parathyroidectomy, for asymptomatic primary hyperparathyroidism: a prospective, randomized trial. J Clin Endocrinol Metab. 2007;92:1687-92. [PMID: 17284629] CrossrefMedlineGoogle Scholar6. Bollerslev J,Rosen T,Mollerup CL, et al; SIPH Study Group. Effect of surgery on cardiovascular risk factors in mild primary hyperparathyroidism. J Clin Endocrinol Metab. 2009;94:2255-61. [PMID: 19351725] doi:10.1210/jc.2008-2742 CrossrefMedlineGoogle Scholar7. Lundstam K,Heck A,Godang K, et al; SIPH Study Group. Effect of surgery versus observation: skeletal 5-year outcomes in a randomized trial of patients with primary HPT (the SIPH study). J Bone Miner Res. 2017;32:1907-14. [PMID: 28543873] doi:10.1002/jbmr.3177 CrossrefMedlineGoogle Scholar8. Pretorius M,Lundstam K,Hellström M, et al. Effects of parathyroidectomy on quality of life: 10 years of data from a prospective randomized controlled trial on primary hyperparathyroidism (the SIPH-study). J Bone Miner Res. 2021;36:3-11. [PMID: 33125769] doi:10.1002/jbmr.4199 CrossrefMedlineGoogle Scholar9. Douglas F,Petrie KJ,Cundy T, et al. Differing perceptions of intervention thresholds for fracture risk: a survey of patients and doctors. Osteoporos Int. 2012;23:2135-40. [PMID: 22065304] doi:10.1007/s00198-011-1823-7 CrossrefMedlineGoogle Scholar10. Trewby PN,Reddy AV,Trewby CS, et al. Are preventive drugs preventive enough? A study of patients' expectation of benefit from preventive drugs. Clin Med (Lond). 2002;2:527-33. [PMID: 12528966] CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAffiliations: Department of Medicine, University of Auckland, Auckland, New ZealandDisclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M22-0922.Corresponding Author: Mark J. Bolland, MBChB, PhD, Bone and Joint Research Group, Department of Medicine, Faculty of Medical and Health Sciences, University of Auckland, Private Bag 92019, Auckland, New Zealand; e-mail, m.[email protected]ac.nz.This article was published at Annals.org on 19 April 2022. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoMortality and Morbidity in Mild Primary Hyperparathyroidism: Results From a 10-Year Prospective Randomized Controlled Trial of Parathyroidectomy Versus Observation Mikkel Pretorius , Karolina Lundstam , Ansgar Heck , Morten W. Fagerland , Kristin Godang , Charlotte Mollerup , Stine L. Fougner , Ylva Pernow , Turid Aas , Ola Hessman , Thord Rosén , Jörgen Nordenström , Svante Jansson , Mikael Hellström , and Jens Bollerslev Metrics June 2022Volume 175, Issue 6Page: 899-900KeywordsCardiovascular diseasesHazard ratioHospital medicineHypercalcemiaHyperparathyroidismKidney stonesMorbidityMortalityRenal diseasesSurgery ePublished: 19 April 2022 Issue Published: June 2022 Copyright & PermissionsCopyright © 2022 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...