Diagnosis and treatment of hyperparathyroidism.

There is currently no ideal long-term medical management for HPT. Estrogen remains an excellent option for selected postmenopausal women. Bisphosphonates provide skeletal protection even though hypercalcemia persists. Calcimimetic drugs appear to offer the best promise for future treatment. For patients who need stabilization as a prelude to surgery, intravenous pamidronate may be very useful. Even if effective long-term therapy is developed for HPT, it must be considered with respect to surgery, which, if successful, is relatively inexpensive and curative. Long-term medical follow-up requires close scrutiny on an indefinite basis. Components of such scrutiny will include periodic health history and physical examination, serum calcium and creatinine concentrations, creatinine clearance, 24 hour urinary calcium excretion, and BMD determinations [10]. If specific drug therapy is given, more frequent monitoring for adverse effects would probably the required.