Summary Statement from a Workshop on Asymptomatic Primary Hyperparathyroidism: A Perspective for the 21st Century

Abstract

Primary hyperparathyroidism is a common endocrine disease in those countries where multichannel screening is in common use, and hypercalcemia is readily detected. As a result of the introduction of the automated serum screening chemistry panel in the United States in the early 1970s, the prevalence and incidence of the disease were found to be much higher than previous estimates. In addition, the clinical profile had shifted from a symptomatic disorder, with hypercalcemic symptoms, kidney stones, overt bone disease, or a specific neuromuscular dysfunction, toward a more asymptomatic state. The modern clinical profile of asymptomatic primary hyperparathyroidism is best characterized as a disorder in which there are neither signs nor symptoms typically associated with hypercalcemia or parathyroid hormone excess. In light of the shift in the clinical profile of primary hyperparathyroidism, it was no longer clear whether parathyroid surgery was a necessary recommendation for all patients with this disease. Other issues related to medical management, surveillance, and defining criteria for diagnosis as well as the recommendation for surgery all led to the convening of a Consensus Development Conference on the Management of Asymptomatic Primary Hyperparathyroidism. This Conference, held at the NIH on October 29–31, 1990, was sponsored by the Office of Medical Applications of Research and the NIDDK.