Hyperparathyroidism
From IDWiki
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
- Serum calcium >0.25 mM/L above the ULN
- 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
- Vertebral fracture
- CrCl <60 mL/min
- Renal stones
- 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.
