Primary hyperparathyroidism: review and recommendations on evaluation, diagnosis, and management. A Canadian and international consensus

A A Khan^{1

2}, D A Hanley³, R Rizzoli⁴, J Bollerslev⁵, J E M Young⁶, L Rejnmark⁷, R Thakker⁸, P D'Amour⁹, T Paul¹⁰, S Van Uum¹⁰, M Zakaria Shrayyef¹¹, D Goltzman¹², S Kaiser¹³, N E Cusano¹⁴, R Bouillon¹⁵, L Mosekilde¹⁶, A W Kung¹⁷, S D Rao¹⁸, S K Bhadada¹⁹, B L Clarke²⁰, J Liu²¹, Q Duh²², E Michael Lewiecki²³, F Bandeira²⁴, R Eastell²⁵, C Marcocci²⁶, S J Silverberg²⁷, R Udelsman²⁸, K Shawn Davison²⁹, J T Potts Jr³⁰, M L Brandi³¹, J P Bilezikian²⁷

Affiliations

¹ McMaster University, Hamilton, Canada. Aliya@mcmaster.ca.
² Bone Research and Education Center, 223-3075 Hospital Gate, Oakville, ON, Canada. Aliya@mcmaster.ca.
³ University of Calgary, Calgary, Canada.
⁴ Division of Bone Diseases, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland.
⁵ University of Oslo, Oslo, Norway.
⁶ McMaster University, Hamilton, Canada.
⁷ Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus, Denmark.
⁸ University of Oxford, Oxford, UK.
⁹ CHUM, Montreal, Canada.
¹⁰ Western University, London, ON, Canada.
¹¹ Division of Endocrinology, University of Toronto, Mississauga, ON, Canada.
¹² McGill University, Montreal, Canada.
¹³ Dalhousie University, Halifax, Canada.
¹⁴ Columbia University College of Physicians and Surgeons, New York, NY, USA.
¹⁵ KU, Leuven, Belgium.
¹⁶ University of Aarhus, Aarhus, Denmark.
¹⁷ University of Hong Kong, Hong Kong, China.
¹⁸ Henry Ford Hospital, Detroit, MI, USA.
¹⁹ Postgraduate Institute of Medical Education and Research, Chandigarth, India.
²⁰ Mayo Clinic, Rochester, MN, USA.
²¹ Rui-Jin Hospital, Shanghai Jiao-Tong University School of Medicine, Shanghai, China.
²² University of California, San Francisco, CA, USA.
²³ New Mexico Clinical Research and Osteoporosis Center, University of New Mexico School of Medicine, Albuquerque, NM, USA.
²⁴ Division of Endocrinology, Diabetes and Metabolic Bone Diseases, Agamenon Magalhaes Hospital, Brazilian Ministry of Health, University of Pernambuco Medical School, Recife, Brazil.
²⁵ Department of Human Metabolism, University of Sheffield, Sheffield, UK.
²⁶ Department for Clinical and Experimental Medicine, University of Pisa, Endocrine Unit 2, University Hospital of Pisa, Pisa, Italy.
²⁷ Division of Endocrinology, Columbia University College of Physicians and Surgeons, New York, NY, USA.
²⁸ Department of Surgery, Yale University School of Medicine, New Haven, CT, USA.
²⁹ University of Victoria, Victoria, BC, Canada.
³⁰ Massachusetts General Hospital, Harvard University, Boston, MA, USA.
³¹ University of Florence, Florence, Italy.

PMID: 27613721
PMCID: PMC5206263
DOI: 10.1007/s00198-016-3716-2

Review

Primary hyperparathyroidism: review and recommendations on evaluation, diagnosis, and management. A Canadian and international consensus

A A Khan et al. Osteoporos Int. 2017 Jan.

. 2017 Jan;28(1):1-19.

doi: 10.1007/s00198-016-3716-2. Epub 2016 Sep 9.

Authors

Affiliations

¹ McMaster University, Hamilton, Canada. Aliya@mcmaster.ca.
² Bone Research and Education Center, 223-3075 Hospital Gate, Oakville, ON, Canada. Aliya@mcmaster.ca.
³ University of Calgary, Calgary, Canada.
⁴ Division of Bone Diseases, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland.
⁵ University of Oslo, Oslo, Norway.
⁶ McMaster University, Hamilton, Canada.
⁷ Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus, Denmark.
⁸ University of Oxford, Oxford, UK.
⁹ CHUM, Montreal, Canada.
¹⁰ Western University, London, ON, Canada.
¹¹ Division of Endocrinology, University of Toronto, Mississauga, ON, Canada.
¹² McGill University, Montreal, Canada.
¹³ Dalhousie University, Halifax, Canada.
¹⁴ Columbia University College of Physicians and Surgeons, New York, NY, USA.
¹⁵ KU, Leuven, Belgium.
¹⁶ University of Aarhus, Aarhus, Denmark.
¹⁷ University of Hong Kong, Hong Kong, China.
¹⁸ Henry Ford Hospital, Detroit, MI, USA.
¹⁹ Postgraduate Institute of Medical Education and Research, Chandigarth, India.
²⁰ Mayo Clinic, Rochester, MN, USA.
²¹ Rui-Jin Hospital, Shanghai Jiao-Tong University School of Medicine, Shanghai, China.
²² University of California, San Francisco, CA, USA.
²³ New Mexico Clinical Research and Osteoporosis Center, University of New Mexico School of Medicine, Albuquerque, NM, USA.
²⁴ Division of Endocrinology, Diabetes and Metabolic Bone Diseases, Agamenon Magalhaes Hospital, Brazilian Ministry of Health, University of Pernambuco Medical School, Recife, Brazil.
²⁵ Department of Human Metabolism, University of Sheffield, Sheffield, UK.
²⁶ Department for Clinical and Experimental Medicine, University of Pisa, Endocrine Unit 2, University Hospital of Pisa, Pisa, Italy.
²⁷ Division of Endocrinology, Columbia University College of Physicians and Surgeons, New York, NY, USA.
²⁸ Department of Surgery, Yale University School of Medicine, New Haven, CT, USA.
²⁹ University of Victoria, Victoria, BC, Canada.
³⁰ Massachusetts General Hospital, Harvard University, Boston, MA, USA.
³¹ University of Florence, Florence, Italy.

PMID: 27613721
PMCID: PMC5206263
DOI: 10.1007/s00198-016-3716-2

Abstract

The purpose of this review is to assess the most recent evidence in the management of primary hyperparathyroidism (PHPT) and provide updated recommendations for its evaluation, diagnosis and treatment. A Medline search of "Hyperparathyroidism. Primary" was conducted and the literature with the highest levels of evidence were reviewed and used to formulate recommendations. PHPT is a common endocrine disorder usually discovered by routine biochemical screening. PHPT is defined as hypercalcemia with increased or inappropriately normal plasma parathyroid hormone (PTH). It is most commonly seen after the age of 50 years, with women predominating by three to fourfold. In countries with routine multichannel screening, PHPT is identified earlier and may be asymptomatic. Where biochemical testing is not routine, PHPT is more likely to present with skeletal complications, or nephrolithiasis. Parathyroidectomy (PTx) is indicated for those with symptomatic disease. For asymptomatic patients, recent guidelines have recommended criteria for surgery, however PTx can also be considered in those who do not meet criteria, and prefer surgery. Non-surgical therapies are available when surgery is not appropriate. This review presents the current state of the art in the diagnosis and management of PHPT and updates the Canadian Position paper on PHPT. An overview of the impact of PHPT on the skeleton and other target organs is presented with international consensus. Differences in the international presentation of this condition are also summarized.

Keywords: Diagnosis; Management; Osteoporosis; Primary hyperparathyroidism; Surgery; Treatment.

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Conflict of interest statement

AA Khan is on the advisory board for Amgen, Eli Lilly, and Merck; has research grants from NPS, Amgen, and Merck; and has received lecture fees from Amgen, Eli Lilly, Warner Chilcott, and Merck; D Hanley has received funding for grants from Amgen, Eli Lilly, Merck, and Novartis; has received funding for lectures from Amgen Eli Lilly and Novartis; and is on the membership board for Amgen, Eli Lilly, Merck, and Novartis; R Rizzoli received consultancy and lecture fees from Amgen, Eli Lilly, MSD, Danone, and Servier; L Rejnmark received consultancy and lecture fees from NPS Pharmaceuticals, Amgen, Eli Lilly, and Novo Nordic; RV Thakker is a chairman of Astra-Zeneca Stratified Medicine Panel and has received lecture and consultancy fees from Novartis, Eli Lilly, AstraZeneca, and Ipsen; S Kaiser has received consultancy fees from Amgen and Eli Lilly and has received lecture fees from Amgen, Eli Lilly, Merck, and NRS; L Mosekilde has received funds for the development of educational presentations; DS Rao is on the advisory board for Diasorin Inc., has received consultancy fees from NPS Pharmaceuticals, has received grants from NIAMS, and has received funding for lectures from Eli Lilly; M Lewiecki has received research grant support from Amgen, Merck, and Eli Lilly and has received consultancy fees from Amgen, Eli Lilly, Merck, Radius Health, AgNovos Healthcare, Theranova, and Alexion; R Eastell received grants, lecture fees, and travel expenses from Amgen, AstraZeneca, IDS, Eli Lilly, Merck, Novartis, Roche, Alexion, Otsuka, IBMS, and Warner Chilcott; KS Davison has received honorarium for lectures from Novartis, Merck, Amgen, and Eli Lilly; and ML Brandi has received consultancy fees and grant funding from Amgen, Eli Lilly, MSD, Novartis, Roche, and Servier. Funding This work was supported by the Calcium Disorders Clinic, McMaster University Hamilton, Ontario, Canada.

Figures

**Fig. 1**
Normal sigmoidal relationship between calcium and PTH [73]

**Fig. 2**
a 4D-CT images of left paraesophageal parathyroid adenoma with feeding vessel. Arterial, 2 mm slices, adenoma measured 8 × 4 × 14 mm on CT (images supplied by Drs. Bart Clarke and Geoffrey B. Thompson of the Mayo Department of Endocrine Surgery, Rochester, MN). b 4D-CT images of left paraesophageal parathyroid adenoma with feeding vessel. c 4D-CT images of left paraesophageal parathyroid adenoma with feeding vessel

**Fig. 3**
99mTC-sestaMIBI-scintigraphy with SPECT and low-dose CT

See this image and copyright information in PMC

References

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1. Khan AA, Hanley DA, O'Brien CJ, Ste-Marie LG, Rotstein LE, Rosen I, Young JEM, Josse RG, Bilezikian JP. Asymptomatic primary hyperparathyroidism - standards and guidelines for diagnosis and management in Canada. Endocr Pract. 2003;9:400–405. doi: 10.4158/EP.9.5.400. - DOI - PubMed
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Primary hyperparathyroidism: review and recommendations on evaluation, diagnosis, and management. A Canadian and international consensus

Affiliations

Primary hyperparathyroidism: review and recommendations on evaluation, diagnosis, and management. A Canadian and international consensus

Authors

Affiliations

Abstract

Conflict of interest statement

Figures

References

Publication types

MeSH terms

Grants and funding

LinkOut - more resources

Full Text Sources

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