Endocrinology Unit, IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo

Over the past 20 years, the Endocrinology Unit of the IRCCS Casa Sollievo della Sofferenza is Reference Centre for the care and management of the patient affected by Primary Hyperparathyroidism. Alfredo Scillitani, the clinical group leader, together with Claudia Battista and Flavia Pugliese, identified, recruited and clinically followed more than 650 PHPT patients and up to 1000 first degree relatives. They also follow and study patients with parathyroid carcinoma belonging to 8 HPT-JT families with a CDC73 gene mutations. Dr Scillitani is the PI of several projects funded by national and international agencies and he contributed to the Italian Guidelines for the management of PHPT patient.

Primary hyperparathyroidism (PHPT) is the 3rd most frequent endocrine disorder. The high frequency of asymptomatic patients pushed the scientific community to draw up guidelines for parathyroid surgery (PTx). According to the guidelines, 40% of asymptomatic patients do not satisfy criteria for surgery and could be followed conservatively over time. Nevertheless, some Authors reported a higher prevalence of chronic complications in PHPT patients not fulfilling surgical criteria and it is not known whether PTx may favourably affect the complications of asymptomatic PHPT patients.

Another point deserves emphasis. The prevalence of vitamin D (VitD) inadequacy (deficiency < 20 ng/mL; insufficiency < 32 ng/mL) is common in general population but it is greater in patients with PHPT. VitD inadequacy has been implicated in several aspects of PHPT and it has also been associated in general population to hypertension, cardiac failure and mortality, diabetes and cancer: all features already associated to PHPT. Based on these observations, we hypothesized that VitD supplementation could influence the natural history of the disease or the recovery of chronic complications after PTx.

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