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      Tratamiento médico del hiperparatiroidismo primario Translated title: Medical treatment of primary hyperparathyroidism

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          Abstract

          RESUMEN Introducción y objetivos: El diagnóstico de hiperparatiroidismo primario en pacientes sin criterio quirúrgico es cada vez más frecuente. Material y métodos: Revisión narrativa. Resultados: Aunque la evidencia de calidad es escasa en algunos casos. Conclusiones: Cada vez se dispone de más datos que nos permiten conocer el efecto de los distintos fármacos sobre la calcemia, la afectación ósea y renal en pacientes sometidos a ellos durante periodos prolongados de tiempo.

          Translated abstract

          ABSTRACT Introduction: The diagnosis of primary hyperparathyroidism in patients without surgical criteria is increasingly frequent. Material and methods: Narrative review. Results: Although quality evidence is scarce in some cases. Conclusions: Last years there are more data available that allow us to know the effect of different drugs on calcemia, bone and kidney involvement in patients undergoing them for prolonged periods of time.

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          Most cited references20

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          Guidelines for the management of asymptomatic primary hyperparathyroidism: summary statement from the Fourth International Workshop.

          Asymptomatic primary hyperparathyroidism (PHPT) is routinely encountered in clinical practices of endocrinology throughout the world. This report distills an update of current information about diagnostics, clinical features, and management of this disease into a set of revised guidelines.
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            Hyperparathyroidism.

            Primary hyperparathyroidism is a common endocrine disorder of calcium metabolism characterised by hypercalcaemia and elevated or inappropriately normal concentrations of parathyroid hormone. Almost always, primary hyperparathyroidism is due to a benign overgrowth of parathyroid tissue either as a single gland (80% of cases) or as a multiple gland disorder (15-20% of cases). Primary hyperparathyroidism is generally discovered when asymptomatic but the disease always has the potential to become symptomatic, resulting in bone loss and kidney stones. In countries where biochemical screening tests are not common, symptomatic primary hyperparathyroidism tends to predominate. Another variant of primary hyperparathyroidism has been described in which the serum calcium concentration is within normal range but parathyroid hormone is elevated in the absence of any obvious cause. Primary hyperparathyroidism can be cured by removal of the parathyroid gland or glands but identification of patients who are best advised to have surgery requires consideration of the guidelines that are regularly updated. Recommendations for patients who do not undergo parathyroid surgery include monitoring of serum calcium concentrations and bone density.
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              The natural history of primary hyperparathyroidism with or without parathyroid surgery after 15 years.

              Primary hyperparathyroidism (PHPT) often presents without classical symptoms such as overt skeletal disease or nephrolithiasis. We previously reported that calciotropic indices and bone mineral density (BMD) are stable in untreated patients for up to a decade, whereas after parathyroidectomy, normalization of biochemistries and increases in BMD ensue. The objective of the study was to provide additional insights in patients with and without surgery for up to 15 yr. The study had an observational design. The setting was a referral center. Patients included 116 patients (25 men, 91 women); 99 (85%) were asymptomatic. Fifty-nine patients (51%) underwent parathyroidectomy and 57 patients were followed up without surgery. BMD was measured. Lumbar spine BMD remained stable for 15 yr. However, BMD started to fall at cortical sites even before 10 yr, ultimately decreasing by 10 +/- 3% (mean +/- sem; P < 0.05) at the femoral neck, and 35 +/- 5%; P < 0.05 at the distal radius, in the few patients observed for 15 yr. Thirty-seven percent of asymptomatic patients showed disease progression (one or more new guidelines for surgery) at any time point over the 15 yr. Meeting surgical criteria at baseline did not predict who would have progressive disease. BMD increases in patients who underwent surgery were sustained for the entire 15 yr. Parathyroidectomy led to normalization of biochemical indices and sustained increases in BMD. Without surgery, PHPT progressed in one third of individuals over 15 yr; meeting surgical criteria at the outset did not predict this progression. Cortical bone density decreased in the majority of subjects with additional observation time points and long-term follow-up. These results raise questions regarding how long patients with PHPT should be followed up without intervention.
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                Author and article information

                Journal
                orl
                Revista ORL
                Rev. ORL
                Ediciones Universidad de Salamanca (Salamanca, Salamanca, Spain )
                2444-7986
                September 2020
                : 11
                : 3
                : 361-368
                Affiliations
                [1] Salamanca orgnameComplejo Asistencial Universitario de Salamanca orgdiv1Servicio de Endocrinología y Nutrición España
                Article
                S2444-79862020000300012 S2444-7986(20)01100300012
                10.14201/orl.21312
                c4b1c6d7-7eb9-4917-8b00-b582b608717b

                This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

                History
                : 19 August 2019
                : 24 August 2019
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 21, Pages: 8
                Product

                SciELO Spain

                Categories
                Artículo de revisión

                Vitamin D,Cinacalcet,Bifosfonatos,Primary Hyperparathyroidism,Denosumab,Bisphosphonates,Vitamina D3,Hiperparatiroidismo primario

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