Primary hyperparathyroidism

Management

Indications for surgery

• Symptomatic hyperparathyroidism, with nephrolithiasis or symptomatic hypercalcemia
• If asymptomatic:
  • Serum calcium ≥0.25 mmol/L above the ULN
  • Skeletal indications
    • T-score <-2.5
    • Asympatomatic vertebral fracture
  • Renal indications
    • eGFR <60 mL/min
    • 24h urine calcium >10 mmol/day
    • Nephrolithiasis or nephrocalcinosis by imaging
  • Age <50 years