DOI: https://doi.org/10.36347/sasjm.2026.v12i10.016

Pages: 1111-1120

Primary hyperparathyroidism (PHPT) is an endocrine disorder characterized by inappropriate, autonomous secretion of parathyroid hormone (PTH), leading to chronic hypercalcemia. It is the third most common endocrinopathy after diabetes mellitus and thyroid disorders. Since the widespread use of automated serum calcium measurement, classical symptomatic forms such as osteitis fibrosa cystica and recurrent nephrolithiasis have become rare, and most patients are now diagnosed at an asymptomatic stage, often during an osteoporosis work-up or following incidental hypercalcemia. The Fifth International Workshop (2022) distinguishes three entities: symptomatic hypercalcemic PHPT, asymptomatic hypercalcemic PHPT with or without targetorgan involvement, and normocalcemic PHPT. The diagnosis is exclusively biochemical, based on hypercalcemia (albumin-corrected or ionized calcium) with an elevated or inappropriately normal PTH, after exclusion of familial hypocalciuric hypercalcemia, vitamin D deficiency and renal impairment. Target-organ assessment includes 24-hour urinary calcium, estimated glomerular filtration rate, renal imaging, bone densitometry at three sites including the distal one-third radius, and vertebral imaging. Localization studies (neck ultrasound, ⁹⁹ᵐTcsestamibi scintigraphy with SPECT/CT, 4D-CT, ¹⁸F-fluorocholine PET/CT) have no diagnostic value and are indicated only before surgery. Parathyroidectomy remains the only curative treatment; its indications were updated in 2022, notably with a lower 24-hour urinary calcium threshold (250 mg/day in women and 300 mg/day in men instead of 400 mg/day). Medical therapy (bisphosphonates, denosumab, cinacalcet) is reserved for patients who are not surgical candidates or who decline surgery, and non-operated patients require regular clinical, biochemical and densitometric follow-up.