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Normocalcemic Primary Hyperparathyroidism: Need for a Standardized Clinical Approach

Since normocalcemic primary hyperparathyroidism (NHPT) was first defined at the Third International Workshop on the Management of Asymptomatic Primary Hyperparathyroidism in 2008, many papers have been published describing its prevalence and possible complications. Guidelines for the management of t...

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Autores principales: Zavatta, Guido, Clarke, Bart L.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Korean Endocrine Society 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8258342/
https://www.ncbi.nlm.nih.gov/pubmed/34107603
http://dx.doi.org/10.3803/EnM.2021.1061
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author Zavatta, Guido
Clarke, Bart L.
author_facet Zavatta, Guido
Clarke, Bart L.
author_sort Zavatta, Guido
collection PubMed
description Since normocalcemic primary hyperparathyroidism (NHPT) was first defined at the Third International Workshop on the Management of Asymptomatic Primary Hyperparathyroidism in 2008, many papers have been published describing its prevalence and possible complications. Guidelines for the management of this condition are still lacking, and making the diagnosis requires fulfillment of strict criteria. Recent studies have shown that intermittent oscillations of serum calcium just below and slightly above the normal limits are very frequent, therefore challenging the assumption that serum calcium must be consistently normal to make the diagnosis. There is debate if these variations in serum calcium outside the normal range should be included under the rubric of NHPT or, rather, a milder form of classical primary hyperparathyroidism. Innovative approaches to define NHPT have been proposed that still need to be validated in prospective studies. Non-classical complications, especially cardiovascular complications, have been associated with NHPT, indicating that hyperparathyroidism may be a cardiovascular risk factor. New associations between parathyroid hormone (PTH) and several other comorbidities have also been reported from observational studies, suggesting that excessive PTH secretion might cause tissue dysfunction independent of serum calcium. Heterogeneous studies using different definitions of NHPT, however, make it difficult to draw definitive conclusions regarding the role of PTH excess when complications other than osteoporosis or kidney stones are described. This review will focus on clinical aspects and suggest an approach to NHPT.
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spelling pubmed-82583422021-07-19 Normocalcemic Primary Hyperparathyroidism: Need for a Standardized Clinical Approach Zavatta, Guido Clarke, Bart L. Endocrinol Metab (Seoul) Review Article Since normocalcemic primary hyperparathyroidism (NHPT) was first defined at the Third International Workshop on the Management of Asymptomatic Primary Hyperparathyroidism in 2008, many papers have been published describing its prevalence and possible complications. Guidelines for the management of this condition are still lacking, and making the diagnosis requires fulfillment of strict criteria. Recent studies have shown that intermittent oscillations of serum calcium just below and slightly above the normal limits are very frequent, therefore challenging the assumption that serum calcium must be consistently normal to make the diagnosis. There is debate if these variations in serum calcium outside the normal range should be included under the rubric of NHPT or, rather, a milder form of classical primary hyperparathyroidism. Innovative approaches to define NHPT have been proposed that still need to be validated in prospective studies. Non-classical complications, especially cardiovascular complications, have been associated with NHPT, indicating that hyperparathyroidism may be a cardiovascular risk factor. New associations between parathyroid hormone (PTH) and several other comorbidities have also been reported from observational studies, suggesting that excessive PTH secretion might cause tissue dysfunction independent of serum calcium. Heterogeneous studies using different definitions of NHPT, however, make it difficult to draw definitive conclusions regarding the role of PTH excess when complications other than osteoporosis or kidney stones are described. This review will focus on clinical aspects and suggest an approach to NHPT. Korean Endocrine Society 2021-06 2021-06-01 /pmc/articles/PMC8258342/ /pubmed/34107603 http://dx.doi.org/10.3803/EnM.2021.1061 Text en Copyright © 2021 Korean Endocrine Society https://creativecommons.org/licenses/by-nc/4.0/This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (https://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Review Article
Zavatta, Guido
Clarke, Bart L.
Normocalcemic Primary Hyperparathyroidism: Need for a Standardized Clinical Approach
title Normocalcemic Primary Hyperparathyroidism: Need for a Standardized Clinical Approach
title_full Normocalcemic Primary Hyperparathyroidism: Need for a Standardized Clinical Approach
title_fullStr Normocalcemic Primary Hyperparathyroidism: Need for a Standardized Clinical Approach
title_full_unstemmed Normocalcemic Primary Hyperparathyroidism: Need for a Standardized Clinical Approach
title_short Normocalcemic Primary Hyperparathyroidism: Need for a Standardized Clinical Approach
title_sort normocalcemic primary hyperparathyroidism: need for a standardized clinical approach
topic Review Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8258342/
https://www.ncbi.nlm.nih.gov/pubmed/34107603
http://dx.doi.org/10.3803/EnM.2021.1061
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