The outcome of treatment and changes in presentation of primary hyperparathyroidism

A review of 105 patients operated on over a 25-year period for primary hyperparathyroidism indicates that the diagnosis is now being made at an earlier stage of the disease. The incidence of bone disease is falling but renal symptoms remain the principal reason for presentation. Hypertension in the presence of established disease persists after successful surgery and renal function frequently continues to deteriorate. Renal function is little affected in patients with minimal symptoms. An accurate diagnosis can be made on the basis of persistent hypercalcaemia and elevated serum parathormone levels in peripheral or neck venous blood measured by sensitive immuno-assay. Surgery is indicated as soon as the diagnosis is established with certainty even in the absence of any symptoms.