Treatment is usually surgical removal of the gland(s) containing adenomas, but medication may also be required. Surgery The surgical removal of one or more of the parathyroid glands is known as a parathyroidectomy; this operation was first performed in 1925. The symptoms of the disease, listed above, are indications for surgery. Surgery reduces all cause mortality as well as resolving symptoms. However, cardiovascular mortality is not significantly reduced. The 2002 NIH Workshop on Asymptomatic<unk>  developed criteria for surgical intervention . The criteria were revised at the Third International Workshop on the Management of Asymptomatic<unk>  . These criteria were chosen on the basis of clinical experience and observational and clinical trial data as to which patients are more likely to have end-organ effects of<unk>  (nephrolithiasis, skeletal involvement), disease progression if surgery is deferred, and the most benefit from surgery. The panel emphasized the need for parathyroidectomy to be performed by surgeons who are highly experienced and skilled in the operation. The Third International Workshop guidelines concluded that surgery is indicated in asymptomatic patients who meet any one of the following conditions: * Serum calcium concentration of 1.0 mg/dL (0.25 mmol/L) or more above the upper limit of normal * Creatinine clearance that is reduced to <60 mL/min * Bone density at the hip, lumbar spine, or distal radius that is more than 2.5 standard deviations below peak bone mass (T score <-2.5) and/or previous fragility fracture * Age less than 50 years Operative intervention can be delayed in patients over 50 years of age who are asymptomatic or minimally symptomatic and who have serum calcium concentrations <1.0 mg/dL (0.2 mmol/L) above the upper limit of normal, and in patients who are medically unfit for surgery More recently, three randomized controlled trials have studied the role of surgery in patients with asymptomatic<unk> . The largest study reported that surgery resulted in an increase in bone mass, but no improvement in quality of life after one to two years among patients in the following groups: * Untreated, asymptomatic<unk>  * Serum calcium between 2.60–2.85 mmol/liter (10.4–11.4 mg/dl) * Age between 50 and 80 yr * No medications interfering with Ca metabolism * No hyperparathyroid bone disease * No previous operation in the neck * Creatinine level < 130 μmol/liter (<1.47 mg/dl) Two other trials reported improvements in bone density and some improvement in quality of life with surgery. Medications Medications that are sometimes required include estrogen replacement therapy in postmenopausal women and bisphosphonates. Bisphosphonates may improve bone turnover. Newer medications termed "calcimimetics" used in secondary<unk>  are now being used in<unk> . Calcimimetics reduce the amount of parathyroid hormone released by the parathyroid glands. They are recommended in patients in whom surgery is inappropriate.
Primary hyperparathyroidism
Secondary hyperparathyroidism
Tertiary hyperparathyroidism
Familial hypocalciuric hypercalcemia
Parathyroid adenoma
Pseudohypoparathyroidism
Normophosphatemic familial tumoral calcinosis
Pseudopseudohypoparathyroidism