Primary Hyperparathyroidism: Asymptomatic Medical Management

Primary hyperparathyroidism (PHPT) is a relatively common endocrine condition being identified now in its early stages following introduction of multichannel biochemical screening and identification of hypercalcemia in those without signs or symptoms of its presence [1]. Previously, PHPT would present clinically with symptomatic hypercalcemia, renal stones, and skeletal complications, including osteitis fibrosa cystic characterized by Brown tumors of the long bones, tapering of the distal clavicles, a salt and pepper appearance of the skull, as well as subperiosteal bone resorption of the distal phalanges. The previous chapter addressed the management of classical PHPT with symptomatic disease. This chapter addresses asymptomatic PHPT characterized by mild hypercalcemia without signs or symptoms of its presence and without target organ complications of skeletal or renal disease.