Non-surgical management of primary hyperparathyroidism.

Abstract

The purpose of this chapter is to discuss the options available for patients with primary hyperparathyrodism (PHPT) not undergoing parathyroidectomy (PTx). Adequate hydration should be recommended in all patients. Calcium intake should not be restricted and vitamin D deficiency should be corrected aiming at a serum concentration of 25OHD of >20 ng/mL or even higher (>30 ng/mL according to some opinion leaders). Pharmacologic therapy is not an alternative to PTx and could be considered in patients who meet the surgical criteria but unwilling to undergo PTx, as well as in patients with an increased risk of surgery or failed surgery. Targeted therapy includes antiresorptive drugs for skeletal protection and cinacalcet for lowering serum calcium. Combined therapy can be an option when appropriate. Pregnant women should be treated conservatively (hydration) and surgery, if needed, performed in the second trimester of pregnancy. Severe hypercalcemia is a life-threatening condition and requires immediate intensive treatment.

• Authors: Filomena Cetani, Federica Saponaro, Claudio Marcocci
• Journal: Best practice & research. Clinical endocrinology & metabolism (Best Pract Res Clin Endocrinol Metab) Vol. 32 Issue 6 Pg. 821-835 (12 2018) ISSN: 1878-1594 [Electronic] Netherlands
• PMID: 30665549 (Publication Type: Journal Article, Review)
• Copyright: Copyright © 2018 Elsevier Ltd. All rights reserved.

Chemical References

• Parathyroid Hormone
• Calcium
• Cinacalcet

Topics

• Calcium (blood)
• Cinacalcet (therapeutic use)
• Female
• Fluid Therapy
• Humans
• Hypercalcemia (etiology, therapy)
• Hyperparathyroidism, Primary (complications, therapy)
• Parathyroid Hormone (blood)
• Parathyroidectomy
• Pregnancy
• Pregnancy Complications (therapy)
• Vitamin D Deficiency (etiology, therapy)