Primary Hyperparathyroidism in Men

Primary hyperparathyroidism (PHPT) is a common endocrine disorder with an estimated prevalence of 3/1000 in the general population, with a male to female ratio of approximately 1:3. After the introduction and widespread application of the automated calcium measurement in the 1970s, the clinical profile of PHPT shifted from a disease that was primarily symptomatic toward a disorder that was primarily asymptomatic at the time of diagnosis. PHPT is the most common cause of hypercalcemia and thus should always be considered in its differential diagnosis. Although over skeletal disease, detected by X-ray is rarely seen, reduction in bone mineral density (BMD) by dual energy X-ray absorptiometry with a predilection to affect cortical bone (e.g. distal 1/3 radius) more than cancellous bone (e.g. lumbar spine) is common. Stone disease is the most common complication of primary hyperparathyroidism. Parathyroidectomy is the definitive treatment and generally recommended in those who meet new revised surgical guidelines. A sustained increase in BMD at all sites is usually observed after surgery. Among those who do not undergo parathyroid surgery, BMD remains quite stable, at least for a decade of monitoring. Medical alternatives are available in those who do not undergo parathyroid surgery and in whom there is a desire to increase BMD (Alendronate) or to reduce the serum calcium concentration (calcimimetics).