Primary hyperparathyroidism (PHPT) is a relatively common disorder affecting 1 in 500 women and 1 in 2000 men aged over 40 years.[8]Marchini GS, Faria KVM, Torricelli FCM, et al. Sporadic primary hyperparathyroidism and stone disease: a comprehensive metabolic evaluation before and after parathyroidectomy. BJU Int. 2018 Feb;121(2):281-288.
https://www.doi.org/10.1111/bju.14072
http://www.ncbi.nlm.nih.gov/pubmed/29124877?tool=bestpractice.com
In the 1970s, the incidence of PHPT in developed countries rose dramatically with the onset of widespread routine use of multi-channel analysers that included measurements of serum calcium levels.[9]Minisola S, Arnold A, Belaya Z, et al. Epidemiology, pathophysiology, and genetics of primary hyperparathyroidism. J Bone Miner Res. 2022 Nov;37(11):2315-29.
https://asbmr.onlinelibrary.wiley.com/doi/10.1002/jbmr.4665
http://www.ncbi.nlm.nih.gov/pubmed/36245271?tool=bestpractice.com
The estimated incidence in the US between 1998 and 2010 was 50 per 100,000 person-years.[10]Yeh MW, Ituarte PH, Zhou HC, et al. Incidence and prevalence of primary hyperparathyroidism in a racially mixed population. J Clin Endocrinol Metab. 2013 Mar;98(3):1122-9.
http://www.ncbi.nlm.nih.gov/pubmed/23418315?tool=bestpractice.com
[11]Griebeler ML, Kearns AE, Ryu E, et al. Secular trends in the incidence of primary hyperparathyroidism over five decades (1965-2010). Bone. 2015 Apr;73:1-7.
http://www.ncbi.nlm.nih.gov/pubmed/25497786?tool=bestpractice.com
In the US, the overall age‐adjusted prevalence rate of PHPT in 2010 was estimated at 233 per 100,000 in women and 85 per 100,000 in men.[10]Yeh MW, Ituarte PH, Zhou HC, et al. Incidence and prevalence of primary hyperparathyroidism in a racially mixed population. J Clin Endocrinol Metab. 2013 Mar;98(3):1122-9.
http://www.ncbi.nlm.nih.gov/pubmed/23418315?tool=bestpractice.com
The incidence and prevalence of PHPT is highest in black people compared to other racial groups.[10]Yeh MW, Ituarte PH, Zhou HC, et al. Incidence and prevalence of primary hyperparathyroidism in a racially mixed population. J Clin Endocrinol Metab. 2013 Mar;98(3):1122-9.
http://www.ncbi.nlm.nih.gov/pubmed/23418315?tool=bestpractice.com
While the condition may affect all age groups, it is uncommon in the first two decades of life, in the absence of inherited syndromes. It is most commonly found in women between 50 and 60 years of age, with a two to three times greater incidence in women compared with men.[2]Wilhelm SM, Wang TS, Ruan DT, et al. The American Association of Endocrine Surgeons guidelines for definitive management of primary hyperparathyroidism. JAMA Surg. 2016 Oct 1;151(10):959-68.
http://jamanetwork.com/journals/jamasurgery/fullarticle/2542667
http://www.ncbi.nlm.nih.gov/pubmed/27532368?tool=bestpractice.com
[6]Walker MD, Silverberg SJ. Primary hyperparathyroidism. Nat Rev Endocrinol. 2018 Feb;14(2):115-25.
https://www.doi.org/10.1038/nrendo.2017.104
http://www.ncbi.nlm.nih.gov/pubmed/28885621?tool=bestpractice.com
Globally, the presentation of PHPT varies greatly. In the US and Europe, most (80%) patients present with asymptomatic disease, but in resource-poor nations, around 80% of patients present with symptoms.[12]Khan AA, Hanley DA, Rizzoli R, et al. Primary hyperparathyroidism: review and recommendations on evaluation, diagnosis, and management. A Canadian and international consensus. Osteoporos Int. 2017 Jan;28(1):1-19.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5206263
http://www.ncbi.nlm.nih.gov/pubmed/27613721?tool=bestpractice.com
[6]Walker MD, Silverberg SJ. Primary hyperparathyroidism. Nat Rev Endocrinol. 2018 Feb;14(2):115-25.
https://www.doi.org/10.1038/nrendo.2017.104
http://www.ncbi.nlm.nih.gov/pubmed/28885621?tool=bestpractice.com
[13]Yadav SK, Johri G, Bichoo RA, et al. Primary hyperparathyroidism in developing world: a systematic review on the changing clinical profile of the disease. Arch Endocrinol Metab. 2020 Apr;64(2):105-10.
https://www.scielo.br/j/aem/a/jP7p64ZsDBFYbQcpzczH6Jp/?lang=en
http://www.ncbi.nlm.nih.gov/pubmed/32236309?tool=bestpractice.com
In countries where routine biochemical screening is less common, patients with PHPT are likely to present with symptomatic disease at a younger age and with more severe clinical and biochemical abnormalities.[13]Yadav SK, Johri G, Bichoo RA, et al. Primary hyperparathyroidism in developing world: a systematic review on the changing clinical profile of the disease. Arch Endocrinol Metab. 2020 Apr;64(2):105-10.
https://www.scielo.br/j/aem/a/jP7p64ZsDBFYbQcpzczH6Jp/?lang=en
http://www.ncbi.nlm.nih.gov/pubmed/32236309?tool=bestpractice.com
The true prevalence of PHPT is unknown, as many patients with documented hypercalcaemia never go on to be evaluated for possible hyperparathyroidism.[14]Lorenz FJ, Beauchamp-Perez F, Manni A, et al. Analysis of time to diagnosis and outcomes among adults with primary hyperparathyroidism. JAMA Netw Open. 2022 Dec 1;5(12):e2248332.
https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2799946
http://www.ncbi.nlm.nih.gov/pubmed/36574247?tool=bestpractice.com
[15]Quilao RJ, Greer M, Stack BC Jr. Investigating the potential underdiagnosis of primary hyperparathyroidism at the University of Arkansas for Medical Sciences. Laryngoscope Investig Otolaryngol. 2020 Aug;5(4):773-7.
https://onlinelibrary.wiley.com/doi/10.1002/lio2.415
http://www.ncbi.nlm.nih.gov/pubmed/32864451?tool=bestpractice.com
[16]Dawood NB, Tseng CH, Nguyen DT, et al. Systems-level opportunities in the management of primary hyperparathyroidism: an informatics-based assessment. J Clin Endocrinol Metab. 2021 Nov 19;106(12):e4993-5000.
https://academic.oup.com/jcem/article/106/12/e4993/6329134
http://www.ncbi.nlm.nih.gov/pubmed/34313755?tool=bestpractice.com