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Management Changes in Primary Hyperparathyroidism

George L. Irvin III, MD; Denise M. Carneiro, MD
JAMA. 2000;284(8):934-936. doi:10.1001/jama.284.8.934.
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With few exceptions, patients with hypercalcemia, normal renal function, and an elevated intact parathyroid hormone level have primary hyperparathyroidism. Currently, definitive treatment of this disease involves parathyroidectomy, which is the surgical removal of hypersecreting parathyroid gland(s), a procedure that involves surgical exploration of the neck, usually under general anesthesia. Patients with overt symptoms associated with this disease (eg, urinary tract stones, bone pain, cognitive symptoms) and marked hypercalcemia (calcium level >1.0 mg/dL [0.25 mmol/L] above normal range) are usually referred for parathyroidectomy. This procedure results in normocalcemia in 95% to 98% of patients and symptomatic improvement in 82%.13 A more difficult management dilemma occurs in the 80% of patients with hyperparathyroidism presenting with mild hypercalcemia and minimal or no symptoms.


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