Primary hyperparathyroidism. Clinical presentation and factors influencing clinical management.

Primary hyperparathyroidism becomes increasingly common with age and affects females four times more commonly than males. We now know that the majority of patients are asymptomatic of the disease and the commonest symptoms are fatigue and lethargy. Because of these facts, it is now appropriate to consider conservative management of primary hyperparathyroidism in the older patient who is asymptomatic or who has only mild symptoms. Further studies are indicated to ascertain whether such a conservative policy is correct.