Medical Therapy for Treatment of Primary Hyperparathyroidism
A subset of patients with symptomatic PHPT meets the criteria for parathyroidectomy but cannot or will not undergo surgical intervention; these patients may benefit from medical therapy. Failure to localize a parathyroid adenoma in the pre-operative work-up is not an indication to consider medical therapy; such patients should undergo bilateral neck exploration.
Although calcimimetics provide an appealing theoretical medical 'solution' to the consequences of active PHPT, data with cinacalcet have been disappointing with respect to bone and renal end points. Cinacalcet is, however, effective in managing the hypercalcaemia of PHPT. Oestrogen and raloxifene improve bone density in PHPT but should only be used in women with specific adjunctive comorbidites. Bisphosphonates are beneficial in prevention of bone density loss in PHPT but trial design has limited the conclusions that can be drawn regarding fracture risk. No medical therapy has been shown to reduce nephrolithiasis in PHPT.
Conclusion
A subset of patients with symptomatic PHPT meets the criteria for parathyroidectomy but cannot or will not undergo surgical intervention; these patients may benefit from medical therapy. Failure to localize a parathyroid adenoma in the pre-operative work-up is not an indication to consider medical therapy; such patients should undergo bilateral neck exploration.
Although calcimimetics provide an appealing theoretical medical 'solution' to the consequences of active PHPT, data with cinacalcet have been disappointing with respect to bone and renal end points. Cinacalcet is, however, effective in managing the hypercalcaemia of PHPT. Oestrogen and raloxifene improve bone density in PHPT but should only be used in women with specific adjunctive comorbidites. Bisphosphonates are beneficial in prevention of bone density loss in PHPT but trial design has limited the conclusions that can be drawn regarding fracture risk. No medical therapy has been shown to reduce nephrolithiasis in PHPT.
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