HIV/AIDS News & Information

Calcimimetics. A more targeted approach to the medical thera­py of primary hyperparathyroidism is to interfere specifically with the production of PTH. A new class of agents that alters the function of the extracellular calcium-sensing receptor offers an exciting new approach to primary hyperparathyroidism. By binding to an allosteric site, these agents increase the affinity of [...]

Pharmacological approaches. At the time of the 2002 Workshop, it was concluded that there were no specific medical or pharma­cological therapies for which there was yet convincing evidence of efficacy and/or safety. Since that time, experience has accumulated with several of these therapies. These include the report from the Women’s Health Initiative that emphasizes increased [...]

If the guidelines offered by the expert panel convened after the Workshop on Aymptomatic Primary Hyperparathyroidism are followed, about 40-50 percent of patients with primary hy- perparathyroidism in the United States will fit into the non-sur­gical, conservative management category. The natural history of this cohort indicates that over a 10-year period, patients in general are [...]

In the hands of an expert parathyroid surgeon, parathyroidec- tomy is a highly successful procedure with infrequent complica­tions. Both the classic approach of neck exploration, usually with efforts to examine all four parathyroid glands and the in­creasingly popular minimimally invasive parathyroidectomy that uses local rather than general anesthesia are associated with cure in over 95 [...]

This discussion is focused entirely upon the patient with asymptomatic primary hyperparathyroidism. Patients with symptoms or signs such as fractures, renal stones and the classic neuromuscular manifestations of primary hyper- parathyroidism should have surgery. Since many patients, however, are not symptomatic, it is important to consider how best to treat these individuals. For example, it [...]

Although the incidence of nephrolithiasis is much less common than its incidence in the classic, older presentation of primary hyperparathyroidism, kidney stones remain the most common manifestation of primary hyperparathyroidism, with estimates placing the incidence of kidney stones now at 15 to 20 percent. Other renal manifestations of primary hyperparathy­roidism include hypercalciuria, which is seen [...]

Skeletal manifestations The demonstration of skeletal involvement in asymptomatic pri­mary hyperparathyroidism depends upon dual energy X-ray absorptiometry (DXA). Classical radiographic features are rarely seen. DXA shows classic pathophysiological effects of PTH in terms of a reduction in bone density of the distal third of the radius, a site of cortical bone. The proclivity of PTH [...]