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Focus on Primary Hyperparathyroidism – Diagnosis, Management and the Role of Calcimimetics

Published Online: June 6th 2011 European Endocrinology, 2009; 5:67-9; DOI: http://doi.org/10.17925/EE.2009.05.00.67
Authors: Peter Schwarz, Munro Peacock, Roger Bouillon
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Abstract
Primary hyperparathyroidism (HPT) is an endocrine disorder characterised by increased serum calcium and inappropriately high parathyroid hormone (PTH). Although identified historically by overt bone disease and kidney stones, following the introduction of routine calcium screening, many patients are now asymptomatic or mildly symptomatic at diagnosis. Diagnosis and management of asymptomatic primary HPT has been addressed by recent guidelines, which note the importance of excluding other potential aetiologies and also present updated surgical criteria for parathyroidectomy. Calcimimetics, such as cinacalcet, are a new option for patients in whom parathyroidectomy is not clinically appropriate or is contraindicated. Clinical trials have shown that cinacalcet can achieve sustained reductions in serum calcium levels in patients with primary HPT. An improved understanding of the pathophysiology of this disorder and new guidelines and pharmacological options have greatly improved the prospects for successful management.

Keywords
Calcimimetics, calcium-sensing receptor, cinacalcet, Third International Workshop, parathyroid, parathyroidectomy, primary hyperparathyroidism

Speakers: Peter Schwarz, Professor and Consultant, Osteoporosis Outpatient Clinic, Director, Research Centre of Ageing and Osteoporosis, Glostrup Hospital, Denmark;Roger Bouillon, Professor and Chairman of Endocrinology, University and University Hospital, Catholic University of Leuven, Belgium; and Munro Peacock, Professor of Medicine, and Director, General Clinical Research Center, Indiana University, US.
Convenor: Amgen (Europe) GmBH, Switzerland.
Disclosure:The workshop and writing of this article were supported by an educational grant from Amgen (Europe) GmBH, Switzerland.Received: 26 May 2009 Accepted: 1 July 2009

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Primary Hyperparathyroidism – An Evolving Disorder

Primary Hyperparathyroidism – An Evolving Disorder
Primary hyperparathyroidism (HPT) is a common endocrine disease characterised by inappropriately high serum levels of parathyroid hormone (PTH) and elevated calcium.Indeed, it is the leading cause of hypercalcaemia in outpatients. Depending on severity, it may be accompanied by hypercalcaemic symptoms, nephrolithiasis, hyperparathyroid bone disease, loss of bone mineral density (BMD) and neuromuscular weakness.The main pathologies underlying the disorder are parathyroid adenoma (~85%), hyperplasia (~15%) or carcinoma (~<1%). Data suggest that the incidence of primary HPT increases with age in both sexes, with a peak occurring in women after 50 years of age. The introduction of routine biochemical screening in the 1970s had a substantial impact on the presentation of primary HPT, changing the clinical profile from kidney stones and overt bone disease to a less defined, more asymptomatic state in those regions where routine screening is available (see Figure 1). Rates of detection have increased correspondingly, with an initial five-fold rise in the number of patients diagnosed with primary HPT, reflecting the identification of this more mildly symptomatic patient group. However, the term ‘asymptomatic’ may be misleading as many patients identified through routine screening can have non-specific symptoms such as fatigue, depression and poor general health. Thus, physicians have been faced with several challenges in this disease in recent years, including the initial increase in numbers of patients with primary HPT and questions regarding the optimal management of individuals with asymptomatic/mildly symptomatic disease. To read full article please click here.

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