An update from the latest workshop on asymptomatic primary hyperparathyroidism

Primary hyperparathyroidism (HPT) is a common endocrine condition with an incidence of 2.8 to 5.8 per 10,000, which increases with age [1]. In the last 2 to 3 decades there has been a shift in the presentation of primary HPT from a disease of ‘‘bones, stones, and groans’’ to a largely asymptomatic disorder usually discovered coincidentally during investigation for other conditions or on a routine biochemical screening [2–4]. It is well established that patients presenting with classical primary HPT characterized by nephrolithiasis, osteitis fibrosa cystica, and neuromuscular complications benefit from parathyroidectomy. This presentation, however, has become increasingly infrequent, with nephrolithiasis reported to occur in approximately 20% of patients with primary HPT, osteitis fibrosa cystica in 2%, and neuromuscular presentation being exceedingly rare [5,6]. A Consensus Development Conference on the Management of Asymptomatic Primary Hyperparathyroidism sponsored by the National Institutes of Health (NIH) was held in October 1990 to review the existing evidence and define the criteria for diagnosis, management, and follow-up of asymptomatic primary HPT [7]. Considerable data have accumulated since 1990 concerning the natural history of asymptomatic primary HPT, the extent of target organ involvement, techniques for preoperative localization of parathyroid glands, and new surgical approaches to parathyroidectomy. Subsequently a Workshop on Asymptomatic Primary Hyperparathyroidism: a Perspective for the Twenty-first Century was held in April 2002 with a goal of reevaluating the conclusions from the 1990 NIH Consensus Development Conference [8]. The workshop panel specifically considered