Modern Trends for Primary Hyperparathyroidism Intervening on Less Biochemically Severe Disease

Rajni Kumari Sah¹, Sabaretnam Mayilvaganan²

^1,2Department of Endocrine and Breast Surgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India

Corresponding Author: Sabaretnam Mayilvaganan, Department of Endocrine and Breast Surgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India, Phone: +91 9655851510, e-mail: drretnam@gmail.com

How to cite this article: Sah RK, Mayilvaganan S. Modern Trends for Primary Hyperparathyroidism Intervening on Less Biochemically Severe Disease. Indian J Endoc Surg Res 2024;19(2):96.

Source of support: Nil

Conflict of interest: Dr Sabaretnam Mayilvaganan is associated as the National Editorial Board member of this journal and this manuscript was subjected to this journal’s standard review procedures, with this peer review handled independently of this editorial board member and his research group.

We discussed with interest in our department Journal club, the article “Modern trends for primary hyperparathyroidism (PHPT) intervening on less biochemically severe disease” by Krumeich LN et al.¹ We congratulate the authors on their publication and dealing with an important aspect of primary hyperparathyroidism which is to deal with less severe biochemical disease with fewer symptoms and less end-organ dysfunction.¹ We also agree with the authors on the issue of treating these PHPT patients, especially milder diseases, not in adherence with the guidelines when there is no increased risk of anesthesia and surgical complications. Even in the developing world, the knife-happy endocrine surgeons now frequently deal with asymptomatic and young primary hyperparathyroidism patients and the decision to operate or observe depends on several factors. The two newer aspects of PHPT: normocalcemic and normohormonal PHPT need an understanding of physiology so that knife-happy surgeons can interpret intraoperative parathyroid hormone (PTH) levels and understand the role of surgical treatment.^2,3 The authors of their study mentioned that the number of indications met at the time of surgery declined over the study period. We believe that the guidelines also kept changing over that period of time and would have a bearing in addition to an increasing number of less severe diseases being operated. The adjuncts used in parathyroid surgery were different during each time period and that also would have contributed to the success of parathyroid surgery. We feel that this article may be pertinent to Indian Endocrine Surgeons since with routine auto analyzer and also with an increase in endocrine surgery fraternity, more asymptomatic patients shall be treated.

REFERENCES

1. Krumeich LN, Santos A, Fraker DL, et al. Modern trends for primary hyperparathyroidism: Intervening on less biochemically severe disease. J Surg Res 2024;296:489–496. DOI: 10.1016/j.jss.2024.01.013.

2. Yankova I, Lilova L, Petrova D, et al. Biochemical characteristics and clinical manifestation of normocalcemic primary hyperparathyroidism. Endocrine 2024;85(1):341–346. DOI: 10.1007/s12020-024-03768-6.

3. Baugh KA, McCoy KL, Leung JH, et al. Normocalcemic hyperparathyroidism: Intervention to differentiate primary from secondary hyperparathyroidism. Surgery 2024;175(1):166–171. DOI: 10.1016/j.surg.2023.06.056.

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