EDITORIAL October 01, 2015 October 01, 2015

The evolution of primary hyperparathyroidism

DOI: 10.1590/2359-3997000000124

Primary hyperparathyroidism (PHPT) is a common endocrine disorder known since the 1920s (); during its near 100 years of history, however, PHPT has proven to be an ever-changing disease. Throughout the developed world, a shift in the presentation of PHPT has happened in the past decades, from cases with severe bone and kidney disease to asymptomatic individuals identified through routine serum calcium screening (). Indeed, cases with osteitis fibrosa cystica have become a rarity, even in developing countries such as Brazil (,), and young endocrinologists in training are sometimes baffled by the gravity of such cases and unsure about their outcome. In parallel with this trend for earlier recognition of PHPT, our understanding of its pathophysiology has also significantly advanced, mainly through the molecular characterization of parathyroid calcium sensing and proliferative pathways, allowing the identification of a genetic predisposition to PHPT (). In this issue of Archives of Endocrinology and Metabolism, two case reports highlight important nuances of this continuously evolving disorder (,).

Oliveira and cols. report a 60 year-old female patient with an orbital brown tumor that significantly regressed after resolution of PHPT (). Notably, her primary complaint was of facial bone swelling (due to the growth of the brown tumor), while typical PHPT symptoms, such as polyuria, constipation and fatigue, went under-noticed. This is an important reminder of how individual perception of disease manifestations affects its recognition, substantiating how severe cases of PHPT might go unrecognized for some time, even in an era of pre-symptomatic diagnosis. It could be argued that if the diagnosis of PHPT had been made prior to the investigation of the nasal mass, imaging might have sufficed to establish the nature of the bony lesion as a brown tumor and to carefully monitor its evolution, potentially rendering a biopsy dispensable. The most important message of this report, however, is to document the regression of the brown tumor following the resolution of PHPT, a prognostic information that can comfort patients and physicians when dealing with severely symptomatic PHPT.

[…]