# Precision stratified treatment of primary hyperparathyroidism based on multilevel emerging biomarkers

## TL;DR

This paper reviews how emerging biomarkers can improve the precision treatment of primary hyperparathyroidism by enabling personalized risk stratification and decision-making.

## Contribution

The paper introduces an integrated framework combining multilevel biomarkers and multidisciplinary decision-making for precision medicine in PHPT.

## Key findings

- Multilevel biomarkers including genetic, epigenetic, and imaging data can refine risk stratification in PHPT.
- An integrated framework is proposed to guide personalized treatment from surgery to long-term monitoring.
- Standardized validation and collaborative studies are needed for clinical translation of precision medicine in PHPT.

## Abstract

Primary hyperparathyroidism (PHPT) is a clinically heterogeneous endocrine disorder whose management has historically been guided by biochemical profiles and symptomatic presentation. However, the limitations of conventional diagnostic and therapeutic strategies—including poor sensitivity in detecting subclinical organ damage and an inability to predict disease progression—have underscored the need for a more nuanced, biomarker-driven approach. Recent advances in multi-omics technologies, functional imaging, and artificial intelligence have enabled the emergence of precision medicine paradigms for PHPT. This review synthesizes evidence on the role of multilevel biomarkers—spanning genetic, epigenetic, non-coding RNA, metabolic, and imaging domains—in refining risk stratification and guiding individualized treatment. We further propose an integrated framework that combines dynamic biomarker profiling with multidisciplinary team (MDT)-based decision-making to facilitate personalized intervention pathways—from surgical planning to long-term surveillance. Despite promising developments, clinical translation remains challenged by the lack of standardized biomarker validation and integrative analytical platforms. Future efforts should prioritize collaborative networks and large-scale prospective studies to establish evidence-based guidelines for implementing precision medicine in PHPT.