Primary Hyperparathyroidism

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Key Clinical PointsPrimary HyperparathyroidismIn primary hyperparathyroidism, serum calcium levels are elevated in the context of nonsuppressed parathyroid hormone levels. It is most often caused by a single parathyroid adenoma.Patients with mild hyperparathyroidism are at increased risk for renal stones, cortical bone loss, and fractures.Evaluation should include measures of serum calcium, intact parathyroid hormone, 25-hydroxyvitamin D, glomerular filtration rate, 24-hour urine calcium excretion, and bone density (including the distal third of the radius), as well as a renal ultrasound examination to detect stones.Surgery is recommended for patients younger than 50 years of age and for patients with clinically significant hypercalcemia, osteoporosis or a fragility fracture, renal calculi, hypercalciuria (especially with a lithogenic urine biochemical profile), or impaired renal function.Medical management includes correction of dietary calcium and vitamin D insufficiency. Cinacalcet lowers serum calcium levels but does not affect rates of bone loss. Bisphosphonates improve bone density, but whether they reduce the risk of fracture is unknown.Surgery does not correct cardiovascular abnormalities in hyperparathyroidism, and whether it alleviates psychiatric and cognitive deficits is a subject of controversy.

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