Epidemiology of Primary Hyperparathyroidism

After the introduction of automated chemistry panels, including the routine measurement of serum calcium, there was a dramatic rise in the incidence of primary hyperparathyroidism (PHPT) in the early 1970s. In addition, the clinical spectrum shifted from complicated symptomatic to uncomplicated asymptomatic disease. After the initial identification of previously unrecognized cases, the incidence rate fell and continued to decline until the middle to late 1990s when the incidence once again increased for uncertain reasons. Postmenopausal women have the highest incidence rate of PHPT and blacks also appear to have a greater risk. Conflicting information exists regarding death in patients with PHPT, with North American data not demonstrating increased mortality compared to European populations, where survival is reduced. Although current cost-effectiveness studies of surgery versus observation of asymptomatic PHPT are limited by the lack of long-term randomized data, available information suggests that surgery benefit exceeds cost after 5-6 years.