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Primary hyperparathyroidism (PHPT) is hypercalcemia caused by inappropriate, autonomous parathyroid hormone (PTH) secretion from one or multiple parathyroid glands. The typical “classic” presentation is an asymptomatic, PTH-dependent hypercalcemia from a single gland adenoma, with or without target organ involvement. The historical “classical” form of PHPT is associated with significant target organ effects and mortality that has declined over time. The diagnosis of “classic,” asymptomatic PHPT relies on biochemical criteria and evaluation of potential target organ effects. The differential diagnosis includes secondary or tertiary hyperparathyroidism, familial hypocalciuric hypercalcemia (FHH), or altered calcium physiology from medications and/or metabolic conditions. The Guidelines for Diagnosis and Management of Primary Hyperparathyroidism (2022) (Bilezikian JP, et al. J Bone Miner Res 37:2293–2314, 2022) were recently updated, including the elements of presentation, pathologic consequences of disease, aspects of surgical evaluation, medical observation, and management. This chapter is a narrative overview of the Guidelines for Diagnosis and Treatment of Primary Hyperparathyroidism including the current evidence-based recommendations.

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Primary Hyperparathyroidism: An Overview of Diagnosis, Treatment, Guidelines, and Recommendations

  • 章节

  • 发表日期：

    2025年

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  • Dana L. Madison

摘要

Primary hyperparathyroidism (PHPT) is hypercalcemia caused by inappropriate, autonomous parathyroid hormone (PTH) secretion from one or multiple parathyroid glands. The typical “classic” presentation is an asymptomatic, PTH-dependent hypercalcemia from a single gland adenoma, with or without target organ involvement. The historical “classical” form of PHPT is associated with significant target organ effects and mortality that has declined over time. The diagnosis of “classic,” asymptomatic PHPT relies on biochemical criteria and evaluation of potential target organ effects. The differential diagnosis includes secondary or tertiary hyperparathyroidism, familial hypocalciuric hypercalcemia (FHH), or altered calcium physiology from medications and/or metabolic conditions. The Guidelines for Diagnosis and Management of Primary Hyperparathyroidism (2022) (Bilezikian JP, et al. J Bone Miner Res 37:2293–2314, 2022) were recently updated, including the elements of presentation, pathologic consequences of disease, aspects of surgical evaluation, medical observation, and management. This chapter is a narrative overview of the Guidelines for Diagnosis and Treatment of Primary Hyperparathyroidism including the current evidence-based recommendations.