REVIEW  SUBCLINICAL ENDOCRINE DISEASE: OLD AND NEW CLINICAL SCENARIOS 

Minerva Endocrinology 2021 September;46(3):262-71

DOI: 10.23736/S2724-6507.20.03215-0

Copyright © 2020 EDIZIONI MINERVA MEDICA

language: English

Normocalcemic primary hyperparathyroidism: an update

Antonio S. SALCUNI ¹, Claudia BATTISTA ², Flavia PUGLIESE ², Carla COLUMBU ¹, Vito GUARNIERI ³, Vincenzo CARNEVALE ⁴, Alfredo SCILLITANI ² ✉

¹ Unit of Endocrinology, University of Cagliari, Cagliari, Italy; ² Unit of Endocrinology, Fondazione IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Foggia, Italy; ³ Division of Medical Genetics, Fondazione IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Foggia, Italy; ⁴ Department of Internal Medicine, Fondazione IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Foggia, Italy

Normocalcemic primary hyperparathyroidism (NPHPT) is diagnosed in the setting of elevated PTH concentrations with consistently normal albumin-adjusted and ionized serum calcium levels, in absence of secondary causes for elevated PTH concentrations. In order to confirm persistence of the hyperparathyroid state, PTH levels should be elevated on at least two occasions over a 3 to 6 months period. The prevalence of NPHPT depends on the population studied. Data from different studies are often not comparable; indeed, different criteria have been used to exclude secondary hyperparathyroidism. Notwithstanding such limits, the prevalence of NPHPT in studies including ionized calcium dosage was between 0.5% and 0.7%. Available data suggest that patients with NPHPT are likely to have more skeletal, kidney and metabolic complications compared to healthy subjects, but almost all studies suffer from possible misclassification of patients due to lack of ionized calcium dosage. The management of NPHPT is controversial in part due to lack of solid data about the natural history. However, surgical treatment is currently performed more frequently than in the past, although studies do not show, so far, a clear benefit from intervention.

KEY WORDS: Hyperparathyroidism, primary; Endocrinology; Review