The aim of management is to normalize serum calcium and reduce PTH levels, leading to improvement in any associated symptoms. Parathyroidectomy (PTx) is the only curative treatment and should be recommended for PHPT patients with symptomatic disease, but also considered in asymptomatic patients who meet surgical criteria defined by international guidelines. Studies of the natural history of asymptomatic PHPT indicate that in the absence of PTx some patients show stability in serum calcium and PTH levels and bone mineral density (BMD) for several years. The guidelines recommend annual monitoring of serum calcium and PTH, and bi-annual measurement of three-site BMD.
Alternative treatment options in patients ineligible for, or unwilling to undergo PTx or failed PTx include the off-label use of bisphosphonates, and the recently approved calcimimetics cinacalcet. Bisphosphonates increase BMD and decrease bone turnover, but have no impact on serum calcium or PTH levels. The calcimimetic cinacalcet reduces serum calcium and PTH and raises serum, but has no effect on BMD. Medical management should be offered to patients with contraindication to surgery or unwilling to have PTx. It could also be considered in selected asymptomatic PHPT patients who meet the surgical criteria for PTx.
17 May 2014 - 20 May 2014