EDITORIAL April 01, 2020 April 01, 2020

The diagnosis of primary hyperparathyroidism in developing countries remains in the past century: still with bones, stone and groans

DOI: 10.20945/2359-3997000000240

The existence of primary hyperparathyroidism (PHP) as a disease was first recognized in the beginning of the last century. After J. B. Collip had discovered the physiological role of parathyroid glands on calcium homeostasis (), other researchers identified increased parathyroid glands in patients with osteitis fibrosa cystica and osteomalacea (). Then, the first parathyroidectomies began to be performed in order to treat PHP in patients severely affected by the disease (). From that time until now, there has been a great gathering of knowledge about this disease, which remains challenging us in its clinical presentation, diagnosis and treatment.

PHP in its classical form is characterized by hypercalcemia with inappropriate parathormone (PTH) concentrations, which is not suppressed, as expected, in the presence of high calcium levels (). It is usually caused by a single parathyroid adenoma, but also can be due to a hyperplasia of multiple glands and, more rarely, adenocarcinomas. The classical picture present bone disease, with pain, brown tumors, deformities and fractures ( osteitis fibrosa cystica ), nephrolithiasis, nephrocalcinosis and manifestations of hypercalcemia, such as nauseas, vomiting, weight loss, polyuria and polydipsia, dehydration, renal insufficiency and neurological symptoms as depression and cognitive impairment (). Because of this diverse and severe clinical picture, it was defined in the past as the disease of “bones, stones and groans”.

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