Editorial: Primary and secondary hyperparathyroidism: from etiology to treatment

Pier Francesco Alesina^1*Gianluca Donatini²Fabio Medas³

• ¹Helios Klinikum Wuppertal, Wuppertal, Germany
• ²Universite de Poitiers, Poitiers, France
• ³Universita degli Studi di Cagliari, Cagliari, Italy

Editorial: Primary and secondary hyperparathyroidism: from etiology to treatment Primary and secondary hyperparathyroidism (HPT) remain challenging and multifaceted conditi ons at the crossroads of endocrinology, surgery, nephrology, and pathology. Although significant progress has been made in diagnostic and therapeutic strategies, many aspects of these disord ers are still under discussion, including surgical indications, imaging modalities, and the role of newer, minimally invasive therapies.The aim of this Research Topic was to provide a platform for clinicians and researchers to present novel findings, share clinical experiences, and stimulate d ebate regarding all aspects of HPT — from etiology and diagnosis to surgical and nonsurgical treatment strategies.Contributions to this Topic reflect the broad spectrum of HPT and highlight the interdisciplinary nature of its management. The articles cover primary HPT, second ary HPT (mainly associated with chronic kidney disease), rare presentations, and emerging tech niques.A mini-review and case report by Meomartino et al. illustrates the diagnostic challenges of intrathyroid al parathyroid adenomas, particularly when misclassified as indeterminate thyroid nodules. The authors highlight the potential value of preoperative calcium-phosphate screening in such cases to avoid unnecessary or incorrect interventions.The study by Hargitai et al. questions whether intraoperative PTH monitoring is still necessary in patients wit h concordant preoperative imaging undergoing minimally invasive parathyroidectomy. Their find ings demonstrate a significant increase in persistent disease when IOPTH is omitted, supporting its continued use even in apparently straightforward cases.Zhou et al. present a large retrospec tive study evaluating over 700 patients with secondary hyperparathyroidism. Their findings emp hasize the importance of anatomical and functional imaging— specifically the combination of 99mTc-MIBI SPECT/CT and high-frequency ultrasound— for accurate preoperative localization, particularly given the high incidence of ectopic glands. Li al. compare microwave ablation with surgical parathyroidectomy, concluding that both impro ve bone mineral density and metabolic parameters, although surgery appears more effective at reducing PTH levels. Microwave ablation, however, shows fewer complications, suggesting a pot ential role in a well selected group of patients.A rare and instructive case by Dinoi et al. discusse s the difficulty of distinguishing between brown tumors and bone metastases in the context of p arathyroid carcinoma. The case underscores the clinical relevance of this distinction, as manag ement and prognosis differ substantially. The authors advocate for histological confirmation, ev en in cases of high clinical suspicion.The metabolomic study by Gan et al. offers a novel perspe ctive on SHPT in non-dialysis CKD patients. Their untargeted metabolomic profiling reveals significant differences in amino acid and lipid metabolism, suggesting potential biomarkers and therapeutic targets for e arly intervention. Lastly, Wang et al. address the role of parathyroid autotransplantation in preve nting permanent hypoparathyroidism following total thyroidectomy with bilateral central neck di ssection. Their findings suggest that while the risk of transient hypoparathyroidism increases wit h the number of autotransplanted glands, permanent hypoparathyroidism was observed only in patients who did not undergo autotransplantation. The articles selected for this issue provide a comprehensive snapshot of the current landscape in hyperparathyroidism research. They emph asize the need for precise diagnosis, individualized treatment, and continued exploration of new diagnostic and therapeutic tools. The Topic also reflects the increasing interest in minimally inv asive alternatives and the integration of molecular techniques into clinical practice.We thank all authors and reviewers for their valuable contributions. We hope that this collection will inspire further research and collaboration to improve outcomes for patients affected by hyperparathyroid disorders.