INDICATIONS TO THE TREATMENT OF PRIMARY ASYMPTOMATIC HYPERPARATHYROIDISM

Abstract

The clinical picture of hyperparathyroidism has gone toward deep modifications in the last few decades, and currently this disease is more frequently asymptomatic. So, the que stion is raising concerning which patients have to be ope rated, due to the substantial benignity of the disease and the lack of well defined symptoms. Classical indications for surgery have been formulated more than a decade ago and are as follows: calcemia higher than 3 mmol/L, previous episode of life threatening hypercalcaemia, reduced creati nine clearance, nephrolithiasis, hypercalciuria, osteoporosis. In the last years other indications have been added, on the basis of clinical and epidemiological studies that have con tributed to broaden our knowledgement on the evolution and complicances of the disease. Among these, the following data have to been kept in mind: history of previous atrau matic fractures, vertebral osteopenia (Z-score <-2), vitamin D deficiency, perimenopausal status, neuromuscular or psy chical disturbances.