Asymptomatic Primary Hyperparathyroidism: Management and Implications

The asymptomatic primary hyperparathyroidism (PHPT) is one of the most common endocrinopathies. Considering relatively slow progression of the disease, the untreated PHPT patients are still at risk of classical (particularly osteoporosis) and non-classical (cardiovascular, neurocognitive and psychosocial) complications. The careful evaluation of subjects, including exclusion of the secondary hyperparathyroidism, is necessary, as some of the patients are normocalcemic even in the presence of the disease complications. There are no established risk factors for developing symptomatic disease. At the moment surgery, particularly minimally invasive procedures, seems the most beneficial and cost-effective therapy for asymptomatic PHPT. According to the 2008 International Workshop guidelines at least part of the patients may be followed-up conservatively, provided that they will be closely monitored for possible progressive disease. Pharmacological approach seems to be an option for such patients. The anti-resorptive therapies, particularly biphosphonates, are effective in management of PHPT-related osteoporosis. Calcimimetics are very promising agents lowering calcium and PTH levels, however costs of the treatment may limit their long-term use in asymptomatic PHPT. Also adequate Vitamin D nutrition is essential for conservative management of such patients. This article outlines different methods and recent patents for the treatment of hyperparathyroidism.