Natural History of Untreated Primary Hyperparathyroidism

In the early descriptions of patients with primary hyperparathyroidism (HPT), the disease was recognized as a rare disorder and was associated with severe incapacitating bone symptoms, prevalent renal stones, devastating muscular weakness, and often early death from renal failure. Since the introduction in the mid-1970s of automated equipment allowing routine measurements of serum calcium by multiphasic laboratory screening on liberal indications, primary HPT has been diagnosed with increased frequency.1 The disease has been revealed to be particularly prevalent in postmenopausal women, and many such patients have had a milder ailment than was common some decades ago. These patients have typically lacked the bone or renal stone complications of HPT and have instead exhibited vague symptoms of fatigue or psychiatric disability or have appeared asymptomatic.12 Because general policies of management in primary HPT have been based on studies of symptomatic patients, it has not been obvious that primary HPT detected at a mild and uncomplicated stage requires the same treatment. Accordingly, it has been suggested that subsets of patients with primary HPT may be subjected to surveillance rather than surgery.34 Concomitantly, the diagnosis of HPT has become easier and more precise with the introduction of new methods for measurement of intact serum parathyroid hormone (PTH). HPT can now be diagnosed with assurance, even in cases with no more than borderline elevations of serum calcium.5 6

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