Primary hyperparathyroidism: Labs to order, Tx to consider
Unexplained kidney stones, osteoporosis, or certain subtle clues may point to hyperparathyroidism. These tests and imaging options can help you to be sure.
PRACTICE RECOMMENDATIONS
› Evaluate suspected cases of primary hyperparathyroidism (PHPT) with serum total calcium, parathyroid hormone (PTH), creatinine, and 25-hydroxy vitamin D levels. A
› Consider 24-hour urine measurement of calcium and creatinine in patients undergoing evaluation for possible PHPT. A
› Obtain bone densitometry at the spine, hip, and distal radius in patients with PHPT. A
Strength of recommendation (SOR)
A Good-quality patient-oriented evidence
B Inconsistent or limited-quality patient-oriented evidence
C Consensus, usual practice, opinion, disease-oriented evidence, case series
Conclusion
Although largely asymptomatic, consider PHPT when patients present with unexplained kidney stones, osteoporosis, or any nonspecific symptoms described earlier. PHPT is diagnosed by detecting an inappropriately high or normal PTH in relation to the Ca2+ level. Medications need to be reviewed, and conditions such as FHH that produce similar symptoms need to be ruled out. Measurement of 25(OH) vitamin D levels is recommended in all patients with PHPT.
Parathyroidectomy is the definitive form of treatment and should be offered to patients who meet any one of the surgical criteria, as described earlier. It can also be offered to patients who do not meet the criteria if they prefer. It is known to decrease the risk of kidney stones and osteoporosis. Medical therapy is primarily for patients who do not meet the criteria as mentioned earlier and for those who cannot and/or are unwilling to undergo surgery.
CORRESPONDENCE
Padmaja Sanapureddy, MD, Department of Primary Care and Medicine, G.V. (Sonny) Montgomery VA Medical Center, 1500 E Woodrow Wilson Ave, Jackson, MS 39216; sanapureddypadmaja@gmail.com.
