Should 'Mild Primary Hyperparathyroidism' be reclassified as 'insidious': is it time to reconsider?

David P. Macfarlane, Ning Yu, Peter T. Donnan, Graham P. Leese

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    Abstract

    Primary hyperparathyroidism (PHPT) is a common incidental finding on routine biochemical testing, affecting around 1% of the population. The majority of individuals will be asymptomatic at diagnosis, with no evidence of end organ damage, and unless individuals aged < 50 years at diagnosis, they are often considered to have 'mild' PHPT, as they do not meet published criteria for parathyroidectomy (PTX). However, there is increasing evidence that 'mild' PHPT is associated with adverse health outcomes. Longterm observational studies describing the natural history of 'mild' PHPT suggest that even though biochemistry may be relatively stable in the majority, bone mineral density (BMD) does decline after approximately 10 years of observation, whereas significant improvements in BMD are seen following PTX. Recent large European record linkage studies of 'mild PHPT' demonstrate significantly increased all-cause and cardiovascular mortality, similar to rates published for patients with PHPT who meet the NIH surgical criteria. 'Mild' PHPT was also associated with increased admissions for nonfatal cardiovascular disease, renal failure, renal stones, fractures, hypertension, psychiatric disease, cancer and diabetes, suggesting that 'insidious' PHPT may be a more appropriate description, or at least that the term 'mild' should be abandoned. Randomized controlled trials (RCTs) have begun to explore the benefits of PTX in this condition, demonstrating improvements in BMD and some psychiatric outcomes at approximately 2 years of follow-up. However, larger, adequately powered, long-term, RCTs will be required to determine whether PTX improves potential long-term morbidity and mortality in patients with PHPT who do not meet standard surgical criteria.

    Original languageEnglish
    Pages (from-to)730-737
    Number of pages8
    JournalClinical Endocrinology
    Volume75
    Issue number6
    DOIs
    Publication statusPublished - 2011

    Keywords

    • ASYMPTOMATIC PRIMARY HYPERPARATHYROIDISM
    • CARDIOVASCULAR RISK-FACTORS
    • BONE-MINERAL DENSITY
    • UNTREATED PRIMARY HYPERPARATHYROIDISM
    • NATIONWIDE COHORT ANALYSIS
    • PARATHYROID SURGERY
    • SERUM-CALCIUM
    • FOLLOW-UP
    • POSTMENOPAUSAL WOMEN
    • AUDIT RESEARCH

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