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Invited Critique
February 2013

The Time Has Come to Redefine the Classic Symptoms of Primary Hyperparathyroidism: Comment on “Parathyroidectomy, Elevated Depression Scores, and Suicidal Ideation in Patients With Primary Hyperparathyroidism”

Author Affiliations

Author Affiliation: Department of Surgery and Oncology, University of Calgary, Calgary, Alberta, Canada.

JAMA Surg. 2013;148(2):115-116. doi:10.1001/2013.jamasurg.328

The diagnosis of primary hyperparathyroidism (pHPT) for clinicians in the 1920s through 1950s was a clinical diagnosis. Long before the ability to measure parathyroid hormone and before automated serum calcium measurements, patients were suspected of having pHPT when they presented with nephrolithiasis, osteitis fibrosis cystica, myopathy, and significant neuropsychiatric symptoms. Yet, much has changed since the first parathyroidectomy in 1925.

Hyperparathyroidism today is a biochemical diagnosis and diagnosed much earlier, with less than 20% of patients displaying these classic symptoms. This has led many authors to use the term asymptomatic pHPT for the remaining 80%. Yet, in the last decade, surgeons have contested that very few patients are truly asymptomatic and many benefit from surgery. At first, it was retrospective reflection by patients, claiming how much better they felt following surgery. Then came the patient-based questionnaires and generic quality of life instruments. However, plagued by small series, lack of control groups, and conflicting data from the 3 randomized trials in this field, widespread acceptance of the existence of vague neuropsychologic symptoms in pHPT and their reversibility with surgery has not been forthcoming.1