The role of primary care physician in the diagnosis of primary hyperparathyroidism

Primary hyperparathyroidism is an endocrinopathy with disturbed calcium, phosphate and bone metabolism. The cause of PHPT is an increased secretion of parathyroid hormone due to solitary adenoma, hyperplasia or parathyroid cancer. Primary hyperparathyroidism is nowadays characterized most commonly either as an asymptomatic disorder with accompanying hypercalcemia or symptoms are evident but not intense. Full symptomatic form of PHPT is characterized usually by rich clinical multiorgan symptomatology: symptoms are atypical and unspecific; diagnosis tends to be challenging. Renal lithiasis is the most common complication of primary hyperparathyroidism. Skeletal manifestations - osteoporosis, fractures or bone cystis are less common. PHPT may manifest as gastrointestinal diseases: peptic ulcers, rarely pancreatitis; cardiovascular symptoms: hypertension, left ventricular hypertrophy; muscles and arthral dysfunction and psychiatric disturbances. Most important for recognition are hypercalcemia, hypercalciuria, hypophosphataemia and high parathormon serum concentration, frequently hyperphosphatasia. The most sensitive imaging examination is parathyroid scintigraphy, ultrasonography, computed tomography of neck and mediastinum, seldom magnetic resonance imaging. Parathyroidectomy is the only effective treatment. If the diagnosis is not established, PHPT may lead to hypercalcemic crisis, renal failure and death. In process of reaching the diagnosis of PHPT very important and particular role play primary care physicians. Early diagnosis and management depend on his diagnostic alertness.