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Jens Bollerslev (Oslo, Norway)

Management of primary hyperparathyroidism

Topics to be covered

The clinical presentation of primary hyperparathyroidism (pHPT) has changed dramatically after increased accessibility to biochemical auto-analysers and the diagnosis is today often made by change in patients without specific symptoms. Operative treatment is recommended in patients with markedly increased calcium levels or typical symptoms. However, the vast majority of patients in the modern clinic do not present organ related symptoms and their calcium levels are only slightly increased, or even within the upper limit of normal. It has been a matter of debate whether neuro-psychiatric symptoms is a clinical manifestation in mild pHPT and to what extent Quality of Life and cognitive function would improve following operation. Systematic randomized studies on these patients with up to two years observation time have so far not indicated benefit of surgery. Several consensus development conferences have discussed management of mild, borderline pHPT during the last twenty years.

Educational goals

After attending this Meet the Professor session, participants will be expected to:

• discuss indications for treatment in pHPT;
• understand differential diagnoses for pHPT;
• work-up also in the elderly
• discuss the value of clinical guidelines.

Target audience

Clinicians with an interest in internal medicine and endocrinology.

Teaching methods

Based on case presentations, indications for operative treatment will be presented, as will conservative management, also in the elderly. As no final answers are given due to the lack of long term prospective studies, the value of international guidelines will be discussed.