Estrogens and progestins in the management of primary hyperparathyroidism.

One of the common dilemmas in clinical endocrine practice is the management of patients with hyperparathyroidism (HPT) who either cannot or will not undertake definitive surgical treatment. Therapeutic decisions would be simplified by the availability of a nonsurgical approach to control biochemical abnormalities and forestall the consequences of this condition. In the short term, oral phosphorus salts can be safe and effective. For chronic therapy, only estrogens and progestins have been examined in sufficient detail to merit discussion. Estrogens normalize serum and urinary calcium in the majority of older women with HPT. Biochemical control is generally maintained for as long as patients continue treatment. The data support the view that estrogen inhibits the actions of PTH, particularly on bone, but does not reduce the abnormal PTH secretion. Androgenic progestins may also lower serum and urinary calcium in HPT, but current data suggest that normalization of serum calcium levels is more likely to occur with estrogen. Although reduction in urinary calcium excretion should prove effective in preventing nephrolithiasis, it is unclear whether hormone therapy provides protection against fracture. Whether or not hormone replacement is prescribed, nonsurgical management requires a highly committed patient who is willing to undergo extensive and prolonged follow-up.