Primary Hyperparathyroidism in Adults: Recent Developments in Diagnosis and Management

Primary hyperparathyroidism has a prevalence of around 1% in the general population. Diagnosis requires biochemical testing of serum (for calcium and parathyroid hormone) and urine (for calcium excretion), as well as wider screening for complications including osteoporosis, renal disease, abdominal symptoms and neuropsychiatric disturbance. In selected individuals, genetic testing is a key consideration because up to 10% have hereditary primary hyperparathyroidism. Surgery is curative, with a minimally invasive approach preferred after identifying the abnormal parathyroid glands on preoperative imaging. Uncertainty surrounds the diagnosis of non-classical manifestations of primary hyperparathyroidism, preoperative imaging algorithms and management pathways in normocalcaemic primary hyperparathyroidism.