Primary Hyperparathyroidism: Treatment Approaches and Surgical Management

Introduction

Primary hyperparathyroidism (PHPT) is a condition characterized by excessive production of parathyroid hormone (PTH), leading to hypercalcemia and associated complications. It often arises due to a parathyroid adenoma, hyperplasia, or, rarely, carcinoma.

Causes and Pathophysiology

The primary cause of PHPT is a benign tumor (adenoma) in one of the parathyroid glands. Excess PTH secretion disrupts calcium homeostasis, increasing calcium levels in the blood and causing symptoms such as fatigue, kidney stones, and bone pain.

Symptoms and Diagnosis

• Fatigue and muscle weakness
• Osteoporosis and fractures
• Nephrolithiasis (kidney stones)
• Gastrointestinal issues such as nausea and constipation
• Depression and cognitive impairment

Diagnosis typically involves measuring serum calcium, PTH levels, and performing imaging techniques like ultrasound or sestamibi scans.

Treatment Approaches

Medical Management

For asymptomatic patients or those unfit for surgery, medications such as bisphosphonates, calcimimetics, and vitamin D supplementation may be used to manage calcium levels.

Surgical Management

Surgery is the definitive treatment for PHPT. The most common procedure is parathyroidectomy, where the affected gland is removed. Minimally invasive approaches, including focused parathyroidectomy, are preferred for suitable candidates.

Postoperative Care

Patients require monitoring for hypocalcemia post-surgery and may need temporary calcium supplementation. Long-term follow-up ensures normal calcium homeostasis and bone density improvement.

Conclusion

Primary hyperparathyroidism is a manageable condition with surgical intervention offering a potential cure. Early diagnosis and appropriate treatment strategies are vital for preventing complications.