Hyperparathyroidism is defined as a disorder which involves over secretion of parathyroid hormone (PTH). Given the etiology, physicians often classify it as primary, secondary, and tertiary causes.
Primary hyperparathyroidism most commonly caused by parathyroid adenoma or hyperplasia. MEN type 1 and 2A are potential risk factors this presentation. Usually, patient was asymptomatic or have mild nonspecific symptoms including fatigue and constipation. Other potential symptoms including abdominal pain, bone pain, neuropsychiatric symptoms, and symptoms from nephrolithiasis.
Diagnostic findings of primary hyperparathyroidism include elevated or inappropriately normal PTH in the context of hypercalcemia. Other conditions with similar lab findings include Familial Hypocalciuric Hypercalcemia which could commonly be differentiated by testing the urinary calcium clearance to creatinine clearance ratio (UCCR). Besides FHH, Tertiary hyperparathyroidism (pts with primary hyperparathyroidism often have low phosphate but patients with tertiary hyperparathyroidism often have high phosphate level) and rarely ectopic PTH production are also in this PTH dependent hypercalcemia category.
In general, asymptomatic primary hyperparathyroidism patients can be managed conservatively initially. Common measures include encourage oral hydration, encourage physical activity, and avoid high calcium diet as well as certain medications (e.g., thiazide, lithium).
For primary hyperparathyroidism patients, surgery can be curative. Indications for parathyroidectomy include:
- Age < 50
- Symptomatic hypercalcemia
- Complications: osteoporosis, previous asymptomatic vertebral fracture, nephrolithiasis or nephrocalcinosis
- Elevated risk of complications: urine calcium excretion > 400mg/day, eGFR < 60, high serum calcium concentration
Familial Hypocalciuric Hypercalcemia - StatPearls - NCBI Bookshelf (nih.gov)
Pro-FHH Calculation (profhh.org)
Primary hyperparathyroidism: Management - UpToDate
-YZ-
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