Hyperparathyroidism (HPT) is a condition of abnormal excessive parathyroid hormone (PTH) production and a resultant calcium and phosphate disturbance. It is broadly categorized into: primary, secondary (e.g. chronic kidney disease), and tertiary. Primary HPT is the commonest metabolic condition requiring surgical intervention. Commonly, it is a result of a single hyperfunctioning adenoma (80%) and less frequently due to multiple gland hyperplaci (~15%). Parathyroid carcinoma is a rare cause (<1%).
Indications for Surgery
- Symptomatic primary HPT ±evidence of end-organ damage (e.g. nephrolithiasis, osteopaenia/porosis).
- Asymptomatic primary HPT (meeting National Institutes of Health (NIH) criteria: age <50 years, osteitis fibrosa cystica, nephrocalcinosis, serum [Ca2+] >1mg/dl above normal range, urinary calcium excretion >400mg/day, reduced bone mineral density >2SD matched controls, surveillance not possible or undesirable).
- Hypercalcaemic crisis (Ca >3.5mmol/L).
- Parathyroid carcinoma.
- Renal HPT (current practice follows evidence-based guideline, e.g. Kidney Disease Outcomes Quality Initiative (KDOQI).