Severe primary hyperparathyroidism

Abstract

Modern-day primary hyperparathyroidism (PHPT) usually presents as mild hypercalcemia and is often asymptomatic. Severe PHPT can present with pathologic fracture related to underlying associated bone disease (osteitis fibrosa cystica) that can often be mistaken for malignancy. Severe, long-standing hypocalcemia with a normal or increased parathyroid hormone (PTH) level, hungry bone syndrome, more commonly occurs after parathyroidectomy in the setting of severe, long-standing PHPT and in the presence of associated bone disease. Treatment with calcium and calcitriol may be required for months following surgery.