Asymptomatic primary hyperparathyroidism: present management and future options

Primary hyperparathyroidism is a common disorder of mineral metabolism characterized by incompletely regulated, excessive secretion of parathyroid hormone from one or more of the parathyroid glands. In adults with the disease, a single, benign adenoma is seen approximately 80 percent of the time, with multiple gland involvement making up for most of the remaining patients. Very rarely, a parathyroid cancer is responsible but malignant parathyroid disease is rare, being seen in less than 0.5 percent of patients with primary hyperparathyroidism. Primary hyperparathyroidism is the most common cause of hypercalcemia and should always be considered in any individual with hypercalcemia. In this article, we will review important clinical and diagnostic features of primary hyperparathyroidism. We will review current recommendations by which the clinician is guided as to the choice between surgery and medical management, and focus then directly on non-surgical options in the management of asymptomatic primary hyperparathyroidism