Primary hyperparathyroidism (PHPT), the most common cause of hypercalcemia, is most often identified in postmenopausal women with hypercalcemia and parathyroid hormone (PTH) levels that are either frankly elevated or inappropriately normal. The clinical presentation of PHPT includes three phenotypes: target organ involvement of the renal and skeletal systems; mild asymptomatic hypercalcemia; and more recently, high PTH levels in the context of persistently normal albumin-corrected and ionized serum calcium values. The factors that determine which of these three clinical presentations is more likely to predominate in a given country include the extent to which biochemical screening is employed, the prevalence of vitamin D deficiency, and whether a medical center or practitioner tends to routinely measure PTH levels in the evaluation of low bone density or frank osteoporosis. When biochemical screening is common, asymptomatic primary hyperparathyroidism is the most likely form of the disease. In countries where vitamin D deficiency is prevalent and biochemical screening is not a feature of the health care system, symptomatic disease with skeletal abnormalities is likely to predominate. Finally, when PTH levels are part of the evaluation for low bone mass, the normocalcemic variant is seen. Guidelines for surgical removal of hyperfunctioning parathyroid tissue apply to all three clinical forms of the disease. If guidelines for surgery are not met, parathyroidectomy can also be an appropriate option if there are no medical contraindications to surgery. In settings where either the serum calcium or bone mineral density is of concern, and surgery is not an option, pharmacological approaches are available and effective. Referencing in this article the most current published articles, we review the different presentations of PHPT, with particular emphasis on recent advances in our understanding of target organ involvement and management.

中文翻译：

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原发性甲状旁腺功能亢进症

原发性甲状旁腺功能亢进症 (PHPT) 是高钙血症的最常见原因，最常见于患有高钙血症和甲状旁腺激素 (PTH) 水平明显升高或异常正常的绝经后妇女。PHPT的临床表现包括三种表型：肾脏和骨骼系统的靶器官受累；轻度无症状高钙血症；最近，在白蛋白校正值和离子化血清钙值持续正常的情况下，PTH 水平升高。决定这三种临床表现中哪一种在特定国家更有可能占主导地位的因素包括生化筛查的使用程度、维生素 D 缺乏症的患病率以及医疗中心或执业医师是否倾向于常规测量 PTH 水平。低骨密度或明显骨质疏松症的评估。当生化筛查很常见时，无症状的原发性甲状旁腺功能亢进症是最有可能的疾病形式。在维生素 D 缺乏症普遍存在且卫生保健系统不具备生化筛查功能的国家，骨骼异常症状性疾病可能占主导地位。最后，当 PTH 水平成为低骨量评估的一部分时，就会出现血钙正常的变异。手术切除功能亢进的甲状旁腺组织的指南适用于该疾病的所有三种临床形式。如果不符合手术指南，并且没有手术禁忌症，甲状旁腺切除术也是一个合适的选择。在血清钙或骨矿物质密度令人担忧且无法选择手术的情况下，药物方法是可行且有效的。在本文中，我们参考了最新发表的文章，回顾了 PHPT 的不同介绍，特别强调了我们对靶器官参与和管理的理解的最新进展。