Hyperparathyroidism

Management of Asymptomatic Hyperparathyroidism

Investigations

• Electryolytes including calcium, phosphate
• ALP (elevated in 10-40%)
• Urea, creatinine
• 25-OH vitamin D
• PTH
• DEXA for bone mineral density and vertebral spine assessment
• 24-hour urine for calcium, creatinine, creatinine clearance, and stone risk profile
• Adomonal imaging by x-ray, ultrasound, or CT
• Optional: HRpQCT, TBS by DEXA, bone turnover markers, FECa, genetic tests

Indications for surgery

1. Serum calcium >0.25 mM/L above the ULN
2. T-score -2.5 or less at L-spine, femoral neck, hip, or distal 1/3 radius
   • Can use Z-score -2.5 or less if under 50 years
3. Vertebral fracture
4. CrCl <60 mL/min
5. Renal stones
6. Age under 50 years

Further Reading

• Bilezikian JP et al. Guidelines for the Management of Asymptomatic Primary Hyperparathyroidism: Summary Statement from the Fourth International Workshop. J Clin Endocrin Metab 2014;99(10):3561–3569.