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      Primary hyperparathyroidism: review and recommendations on evaluation, diagnosis, and management. A Canadian and international consensus

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          Abstract

          The purpose of this review is to assess the most recent evidence in the management of primary hyperparathyroidism (PHPT) and provide updated recommendations for its evaluation, diagnosis and treatment. A Medline search of "Hyperparathyroidism. Primary" was conducted and the literature with the highest levels of evidence were reviewed and used to formulate recommendations. PHPT is a common endocrine disorder usually discovered by routine biochemical screening. PHPT is defined as hypercalcemia with increased or inappropriately normal plasma parathyroid hormone (PTH). It is most commonly seen after the age of 50 years, with women predominating by three to fourfold. In countries with routine multichannel screening, PHPT is identified earlier and may be asymptomatic. Where biochemical testing is not routine, PHPT is more likely to present with skeletal complications, or nephrolithiasis. Parathyroidectomy (PTx) is indicated for those with symptomatic disease. For asymptomatic patients, recent guidelines have recommended criteria for surgery, however PTx can also be considered in those who do not meet criteria, and prefer surgery. Non-surgical therapies are available when surgery is not appropriate. This review presents the current state of the art in the diagnosis and management of PHPT and updates the Canadian Position paper on PHPT. An overview of the impact of PHPT on the skeleton and other target organs is presented with international consensus. Differences in the international presentation of this condition are also summarized.

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          Incidence and prevalence of primary hyperparathyroidism in a racially mixed population.

          The epidemiology of primary hyperparathyroidism (PHPT) has generally been studied in Caucasian populations. The aim was to examine the incidence and prevalence of PHPT within a racially mixed population. A descriptive epidemiologic study was performed. The study population included 3.5 million enrollees within Kaiser Permanente Southern California. All patients with at least one elevated serum calcium level (>10.5 mg/dL, 2.6 mmol/L) between 1995 and 2010 were included. Cases of PHPT were identified by electronic query of laboratory values using biochemical criteria, after exclusion of secondary or renal and tertiary hyperparathyroidism cases. The incidence and prevalence rates of PHPT were calculated according to sex, race, age group by decade, and year. Initial case finding identified 15,234 patients with chronic hypercalcemia, 13,327 (87%) of which had PHPT as defined by elevated or inappropriately normal parathyroid hormone levels. The incidence of PHPT fluctuated from 34 to 120 per 100,000 person-years (mean 66) among women, and from 13 to 36 (mean 25) among men. With advancing age, incidence increased and sex differences became pronounced (incidence 12-24 per 100,000 for both sexes younger than 50 y; 80 and 36 per 100,000 for women and men aged 50-59 y, respectively; and 196 and 95 for women and men aged 70-79 y, respectively). The incidence of PHPT was highest among blacks (92 women; 46 men, P < .0001), followed by whites (81 women; 29 men), with rates for Asians (52 women, 28 men), Hispanics (49 women, 17 men), and other races (25 women, 6 men) being lower than that for whites (P < .0001). The prevalence of PHPT tripled during the study period, increasing from 76 to 233 per 100,000 women and from 30 to 85 per 100 000 men. Racial differences in prevalence mirrored those found in incidence. PHPT is the predominant cause of hypercalcemia and is increasingly prevalent. Substantial differences are found in the incidence and prevalence of PHPT between races.
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            Guidelines for the management of asymptomatic primary hyperparathyroidism: summary statement from the third international workshop.

             A. K. Azad Khan,  J. Potts,   (2009)
            Asymptomatic primary hyperparathyroidism (PHPT) is a common clinical problem. The purpose of this report is to guide the use of diagnostics and management for this condition in clinical practice. Interested professional societies selected representatives for the consensus committee and provided funding for a one-day meeting. A subgroup of this committee set the program and developed key questions for review. Consensus was established at a closed meeting that followed and at subsequent discussions. Each question was addressed by a relevant literature search (on PubMed), and the data were presented for discussion at the group meeting. Consensus was achieved by a group meeting. Statements were prepared and reviewed by all authors who represented the Planning Committee and the participating professional societies.
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              Diagnosis of asymptomatic primary hyperparathyroidism: proceedings of the Fourth International Workshop.

              Asymptomatic primary hyperparathyroidism (PHPT) is a common clinical problem. The purpose of this report is to provide an update on the use of diagnostic tests for this condition in clinical practice. This subgroup was constituted by the Steering Committee to address key questions related to the diagnosis of PHPT. Consensus was established at a closed meeting of the Expert Panel that followed. Each question was addressed by a relevant literature search (on PubMed), and the data were presented for discussion at the group meeting. Consensus was achieved by a group meeting. Statements were prepared by all authors, with comments relating to accuracy from the diagnosis subgroup and by representatives from the participating professional societies. We conclude that: 1) reference ranges should be established for serum PTH in vitamin D-replete healthy individuals; 2) second- and third-generation PTH assays are both helpful in the diagnosis of PHPT; 3) normocalcemic PHPT is a variant of the more common presentation of PHPT with hypercalcemia; 4) serum 25-hydroxyvitamin D concentrations should be measured and, if vitamin D insufficiency is present, it should be treated as part of any management course; 5) genetic testing has the potential to be useful in the differential diagnosis of familial hyperparathyroidism or hypercalcemia.
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                Author and article information

                Contributors
                905-844-5677 , Aliya@mcmaster.ca
                Journal
                Osteoporos Int
                Osteoporos Int
                Osteoporosis International
                Springer London (London )
                0937-941X
                1433-2965
                9 September 2016
                9 September 2016
                2017
                : 28
                : 1
                : 1-19
                Affiliations
                [1 ]McMaster University, Hamilton, Canada
                [2 ]Bone Research and Education Center, 223-3075 Hospital Gate, Oakville, ON Canada
                [3 ]University of Calgary, Calgary, Canada
                [4 ]Division of Bone Diseases, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
                [5 ]University of Oslo, Oslo, Norway
                [6 ]Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus, Denmark
                [7 ]University of Oxford, Oxford, UK
                [8 ]CHUM, Montreal, Canada
                [9 ]Western University, London, ON Canada
                [10 ]Division of Endocrinology, University of Toronto, Mississauga, ON Canada
                [11 ]McGill University, Montreal, Canada
                [12 ]Dalhousie University, Halifax, Canada
                [13 ]Columbia University College of Physicians and Surgeons, New York, NY USA
                [14 ]KU, Leuven, Belgium
                [15 ]University of Aarhus, Aarhus, Denmark
                [16 ]University of Hong Kong, Hong Kong, China
                [17 ]Henry Ford Hospital, Detroit, MI USA
                [18 ]Postgraduate Institute of Medical Education and Research, Chandigarth, India
                [19 ]Mayo Clinic, Rochester, MN USA
                [20 ]Rui-Jin Hospital, Shanghai Jiao-Tong University School of Medicine, Shanghai, China
                [21 ]University of California, San Francisco, CA USA
                [22 ]New Mexico Clinical Research and Osteoporosis Center, University of New Mexico School of Medicine, Albuquerque, NM USA
                [23 ]Division of Endocrinology, Diabetes and Metabolic Bone Diseases, Agamenon Magalhaes Hospital, Brazilian Ministry of Health, University of Pernambuco Medical School, Recife, Brazil
                [24 ]Department of Human Metabolism, University of Sheffield, Sheffield, UK
                [25 ]Department for Clinical and Experimental Medicine, University of Pisa, Endocrine Unit 2, University Hospital of Pisa, Pisa, Italy
                [26 ]Division of Endocrinology, Columbia University College of Physicians and Surgeons, New York, NY USA
                [27 ]Department of Surgery, Yale University School of Medicine, New Haven, CT USA
                [28 ]University of Victoria, Victoria, BC Canada
                [29 ]Massachusetts General Hospital, Harvard University, Boston, MA USA
                [30 ]University of Florence, Florence, Italy
                Article
                3716
                10.1007/s00198-016-3716-2
                5206263
                27613721
                © The Author(s) 2016

                Open Access This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International License (http://creativecommons.org/licenses/by-nc/4.0/), which permits any noncommercial use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.

                Funding
                Funded by: Calcium Disorders Clinic - St. Joseph's Healthcare Hamilton
                Categories
                Review
                Custom metadata
                © International Osteoporosis Foundation and National Osteoporosis Foundation 2017

                Orthopedics

                diagnosis, management, osteoporosis, primary hyperparathyroidism, surgery, treatment

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