Materiały źródłowe

• #1 Primary hyperparathyroidism: Diagnosis, differential diagnosis, and evaluation – UpToDate

  http://www.uptodate.com/contents/diagnosis-and-differential-diagnosis-of-primary-hyperparathyroidism

  Primary hyperparathyroidism: Diagnosis, differential diagnosis, and evaluation […] The diagnosis of hyperparathyroidism is usually first suspected because of the finding of an elevated serum calcium concentration. If hypercalcemia is confirmed on a repeat sample, all potential causes should be considered. […] The serum parathyroid hormone (PTH) concentration should then be measured using a two-site immunoradiometric sandwich assay. The diagnosis of primary hyperparathyroidism (PHPT) is usually made by finding a PTH concentration that is frankly elevated or within the normal range but inappropriately normal given the patient’s hypercalcemia. […] The diagnosis, differential diagnosis, and evaluation of PHPT will be discussed here.

• #1 Hyperparathyroidism – Diagnosis & treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/hyperparathyroidism/diagnosis-treatment/drc-20356199

  In most cases, elevated calcium is found by blood tests ordered for other reasons. For example, routine blood work or testing to figure out the cause of symptoms of another condition. Your provider may diagnose hyperparathyroidism by ordering: […] If blood test results show that you have high calcium levels in your blood, your health care provider will likely repeat the test. This repeated test can confirm the results after you haven’t eaten for a period of time. […] But your health care provider can diagnose hyperparathyroidism if blood tests show you also have high levels of parathyroid hormone. […] After diagnosing primary hyperparathyroidism, your health care provider will likely order more tests. These can rule out possible conditions causing hyperparathyroidism, identify possible complications and determine the severity of the condition.

• #1 Hyperparathyroidism | AAFP

  https://www.aafp.org/pubs/afp/issues/2004/0115/p333.html

  Primary hyperparathyroidism is the most frequent cause of hypercalcemia in ambulatory patients. […] Persistent hypercalcemia and an elevated serum parathyroid hormone level are the diagnostic criteria for primary hyperparathyroidism. […] Primary hyperparathyroidism usually is easily distinguishable from malignancy, which is the second most common cause of hypercalcemia. Laboratory measurements of the mediators of calcium metabolism are reliable and facilitate determination of etiologic factors in almost all patients with hypercalcemia. […] Persistent hypercalcemia and an elevated serum PTH level confirm the diagnosis of primary hyperparathyroidism. […] Further laboratory testing is unnecessary because other causes of hypercalcemia rarely are associated with elevated PTH levels. […] Hypercalcemia should be confirmed by repeated measurements of serum calcium concentrations, because all patients with primary hyperparathyroidism do not have demonstrable hypercalcemia every time the serum calcium level is measured.

• #1 Hyperparathyroidism | AAFP

  https://www.aafp.org/pubs/afp/issues/2004/0115/p333.html

  Intact PTH (the entire 1 through 84 amino acid sequence) can be measured by immunoradiometric assay or immunochemical assay. […] Once the diagnosis of primary hyperparathyroidism is confirmed biochemically, bone mineral density should be measured in three sites (lumbar spine, hip, forearm), and the patient should be evaluated for renal complications.

• #1 Hyperparathyroidism: What It Is, Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/14454-hyperparathyroidism

  Hyperparathyroidism is when your parathyroid glands produce too much parathyroid hormone (PTH). This can cause high levels of calcium in your blood. Hyperparathyroidism can be primary (caused by growths or enlarged glands) or secondary (caused by kidney disease or low calcium levels). Treatments include surgery, medications and lifestyle changes. […] Healthcare providers diagnose hyperparathyroidism by measuring your calcium, vitamin D and parathyroid hormone levels. Theyll also check your kidney function. […] Primary hyperparathyroidism causes high levels of calcium in your blood and pee, and low levels of phosphate in your blood. Secondary hyperparathyroidism causes low levels of vitamin D, normal or low levels of calcium and high levels of phosphate in your blood. Providers often find hyperparathyroidism during routine tests before you have symptoms.

• #1 Hyperparathyroidism Diagnosis for Parathyroid Disease | Dr. Larian

  https://www.hyperparathyroidmd.com/diagnosis/

  Secondary HPT is usually caused by kidney failure; it occurs if the kidneys are unable to remove phosphorus from the body and cannot produce a sufficient amount of vitamin D. Tests may be used to assess a patient’s vitamin D levels, bone mineral density, and urine calcium levels. With this information, Dr. Larian can determine if a patient is dealing with secondary HPT and provide proper diagnosis and treatment. […] In order to be able to diagnose a person with hyperparathyroidism, looking at the whole person, and what is happening to them is very important. Going through the symptoms they are experiencing and the impact of those symptoms on their life can give not only help the doctor with the diagnosis, but also figure out the how severely hyperparathyroidism is affecting the person. This information will play an important part in deciding to treat or not, what course of treatment to chose, and if surgery is appropriate when to do the surgery.

• #1 Hyperparathyroidism (primary) NICE guideline: diagnosis, assessment, and initial management | British Journal of General Practice

  https://bjgp.org/content/70/696/362

  The albumin-adjusted serum calcium measurement should be repeated in primary care at least once if the first measurement is either 2.6 mmol/L; or 2.5 mmol/L and features of PHPT are present. […] PTH should be measured in patients whose albumin-adjusted serum calcium level is either 2.6 mmol/L on at least two separate occasions; or 2.5 mmol/L on at least two separate occasions and PHPT is suspected. […] The guideline advises referral to a specialist with expertise in PHPT if a patients PTH measurement is: […] above the midpoint of the reference range and PHPT is suspected; or […] below the midpoint of the reference range with a concurrent albumin-adjusted serum calcium level of 2.6 mmol/L. […] The diagnosis of PHPT will be confirmed by secondary care specialists who at diagnosis should:

• #1 Hyperparathyroidism – Wikipedia

  https://en.wikipedia.org/wiki/Hyperparathyroidism

  The diagnosis of primary hyperparathyroidism is made by finding elevated calcium and PTH in the blood. […] The gold standard of diagnosis is the PTH immunoassay. Once an elevated PTH has been confirmed, the goal of diagnosis is to determine the type of hyperparathyroidism (primary, secondary, or tertiary hyperparathyroidism) by obtaining a serum calcium, phosphate, and PTH levels. […] Primary hyperparathyroidism has high calcium, vitamin D, and PTH levels and a low phosphate level. […] Secondary hyperparathyroidism has low serum calcium and vitamin D levels, and high phosphate and PTH levels. […] Tertiary hyperparathyroidism has high serum calcium, phosphate, and PTH and low vitamin D levels. […] Hyperparathyroidism can cause hyperchloremia and increase renal bicarbonate loss, which may result in a normal anion gap metabolic acidosis.

• #1 Primary Hyperparathyroidism – NIDDK

  https://www.niddk.nih.gov/health-information/endocrine-diseases/primary-hyperparathyroidism

  How do doctors diagnose primary hyperparathyroidism? Doctors diagnose primary hyperparathyroidism when a blood test shows high blood calcium and PTH levels. […] Once doctors diagnose hyperparathyroidism, a 24-hour urine collection can help find the cause. This test measures certain chemicals, such as calcium and creatinine, a waste product that healthy kidneys remove. […] Once doctors diagnose primary hyperparathyroidism, they may use other tests to look for bone weakness, kidney problems, and low levels of vitamin D. […] How do doctors treat primary hyperparathyroidism? Guidelines help doctors to decide whether or not parathyroid surgery should be recommended. […] Surgery to remove the overactive parathyroid gland or glands is the only sure way to cure primary hyperparathyroidism.

• #1 Hyperparathyroidism: Background, Anatomy and Embryology, Primary Hyperparathyroidism

  https://emedicine.medscape.com/article/127351-overview

  A subset of patients has normal calcium levels with elevated parathyroid hormone, so-called normocalcemic hyperparathyroidism. […] Testing of the intact parathyroid hormone level is the core of the diagnosis. An elevated intact parathyroid hormone level with an elevated ionized serum calcium level is diagnostic of primary hyperparathyroidism. […] Imaging studies are not used to make the diagnosis of primary hyperparathyroidism (which is based on laboratory data) or to make a decision about whether to pursue surgical therapy (which is based on clinical criteria). […] Surgical excision of abnormal parathyroid glands offers the only permanent, curative treatment for primary hyperparathyroidism. […] Guidelines for the management of primary hyperparathyroidism were updated in 2022 by the Fifth International Workshop on the Evaluation and Management of Primary Hyperparathyroidism.

• #1 Hyperparathyroidism – Endocrine and Metabolic Disorders – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/endocrine-and-metabolic-disorders/parathyroid-disorders/hyperparathyroidism

  Imaging studies of the parathyroid(s) may be done preoperatively to localize an abnormal gland; imaging is not done to establish the diagnosis or determine whether surgery is needed. […] Many imaging techniques have been used effectively, including the following: High-resolution CT with or without CT-guided biopsy and PTH immunoassay from thyroid venous drainage, Contrast-enhanced four-dimensional (4D) CT, MRI, High-resolution ultrasound, Digital subtraction angiography, Thallium-201technetium-99 scanning. […] Technetium-99 sestamibi, a radionuclide agent for parathyroid imaging, is more sensitive and specific than other agents and may be useful for identifying solitary adenomas. […] For residual or recurrent hyperparathyroidism after initial parathyroid surgery, imaging is necessary and may reveal abnormally functioning parathyroid glands in unusual locations throughout the neck and mediastinum.

• #1 Hyperparathyroidism Diagnosis for Parathyroid Disease | Dr. Larian

  https://www.hyperparathyroidmd.com/diagnosis/

  Hyperparathyroidism (HPT) often presents vague symptoms that can occur with other diseases and conditions, so parathyroid disease diagnosis often requires laboratory tests. A Canadian osteoporosis study showed that 1.4% of the population had typical HPT with high levels of calcium and parathyroid hormone (PTH), which is relatively easy to diagnose. However, another 3.3% of the population had normocalcemic HPT, which means they had normal calcium levels and elevated PTH levels. This group of patients is often misdiagnosed because their calcium level is in the normal range, and routine testing does not account for PTH. As a result, their disease will continue to progress until they develop more severe symptoms, including kidney stones or osteoporosis. The disease entity “normocalcemic hyperparathyroidism” was officially recognized in 2008; yet today, most physicians have still not been taught about it.

• #1 Normocalcemic Primary Hyperparathyroidism – Endocrine Surgery | UCLA Health

  https://www.uclahealth.org/medical-services/surgery/endocrine-surgery/conditions-treated/parathyroid/normocalcemic-primary-hyperparathyroidism

  Normocalcemic primary hyperparathyroidism (nPHPT) is suspected when patients calcium level is within the normal range, but parathyroid hormone level is too high. […] Proper diagnosis of normocalcemic primary hyperparathyroidism is challenging, because there are several other causes of high parathyroid hormone levels and normal calcium levels. Because several other conditions may mimic normocalcemic primary hyperparathyroidism, detailed blood and sometimes urine testing is required to establish the definitive diagnosis. […] To diagnose normocalcemic primary hyperparathyroidism, other conditions that may cause high parathyroid hormone levels need to be ruled out. […] In secondary hyperparathyroidism, the parathyroid gland is functioning normally and is only producing high levels of parathyroid hormone because the body is signaling that it needs more calcium in the blood.

• #1

  https://reu.termedia.pl/Primary-hyperparathyroidism-clinical-manifestations-diagnosis-and-evaluation-according,170705,0,2.html

  Primary hyperparathyroidism diagnosis is based on identifying an elevated serum calcium concentration adjusted for albumin in the presence of an elevated or inappropriately high intact PTH level twice at least 2 weeks apart. […] Normocalcemic PHPT is diagnosed when elevated intact PTH along with normal adjusted total calcium and normal ionized calcium concentration is present on at least two occasions over 3-6 months after ruling out all causes of secondary hyperparathyroidism (including stage 3 chronic kidney disease, vitamin D deficiency, calcium malabsorption, bisphosphonate or denosumab use). […] The greatest diagnostic challenge in differential diagnosis of PHPT is caused by FHH, a genetically heterogenous disease due to inactivating mutations of calcium-sensing receptor (CaSR), which causes a shift of the Ca-PTH set point to the right.

• #1

  https://reu.termedia.pl/Primary-hyperparathyroidism-clinical-manifestations-diagnosis-and-evaluation-according,170705,0,2.html

  The differential diagnosis is important, as in FHH organ damage is not observed and parathyroidectomy does not cure hypercalcemia, so it is contraindicated. […] According to current guidelines the following tests should be performed to diagnose PHPT and to assess its severity: total serum calcium adjusted to albumin level, phosphorus, intact PTH, 25(OH)D, creatinine and ionized calcium if normocalcemic PHPT is considered. […] The key decision to be made is whether the patient should undergo parathyroidectomy, which is the only curative treatment of PHPT. […] Surgery is recommended in all symptomatic PHPT patients and in those asymptomatic ones who meet one of the criteria listed in Table II. […] There are no guidelines for surgery in normocalcemic PHPT due to limited data. […] Genetic testing should be considered for patients: 30 years old, with multi-glandular disease, with family history of hypercalcemia and/or syndromes associated with PHPT.

• #1 Hyperparathyroidism (primary) NICE guideline: diagnosis, assessment, and initial management

  https://pmc.ncbi.nlm.nih.gov/articles/PMC7319687/

  Initial diagnostic testing for suspected PHPT within primary care requires the measurement of albumin-adjusted serum calcium and PTH levels. […] Patients should have their albumin-adjusted serum calcium measured if they have any of the following features: symptoms of hypercalcaemia such as thirst, frequent or excessive urination, or constipation; osteoporosis or previous fragility fracture; a renal stone; or an incidental finding of elevated albumin-adjusted serum calcium (2.6 mmol/L). […] The albumin-adjusted serum calcium measurement should be repeated in primary care at least once if the first measurement is either 2.6 mmol/L; or 2.5 mmol/L and features of PHPT are present. […] PTH should be measured in patients whose albumin-adjusted serum calcium level is either 2.6 mmol/L on at least two separate occasions; or 2.5 mmol/L on at least two separate occasions and PHPT is suspected.

• #1 Evolution of the Diagnosis and Treatment of Primary Hyperparathyroidism

  https://www.mdpi.com/2077-0383/12/5/2057

  This study aims to present the evolution of our center’s approach to treating primary hyperparathyroidism (PHPT) from diagnosis to intraoperative interventions. […] The preoperative diagnostic procedure included neck ultrasonography in all patients, [99mTc]Tc-MIBI scintigraphy in 278 patients, and, in 20 doubtful cases, [18F] fluorocholine positron emission tomography (PET) computed tomography (CT) was performed. […] Classic preoperative localization techniques include ultrasonography and nuclear scintigraphy, while the intraoperative procedures we have employed are intraoperative PTH assay (IO PTH-assay) and indocyanine green (ICG) angiography. […] Successful preoperative and intraoperative localization of the parathyroid gland enables a minimally invasive approach and eliminates the need for routine 4-gland exploration, thereby decreasing the risk of bilateral recurrent laryngeal nerve injury or hypoparathyroidism.

• #1 Hyperparathyroidism (primary) NICE guideline: diagnosis, assessment, and initial management

  https://pmc.ncbi.nlm.nih.gov/articles/PMC7319687/

  The guideline advises referral to a specialist with expertise in PHPT if a patients PTH measurement is: above the midpoint of the reference range and PHPT is suspected; or below the midpoint of the reference range with a concurrent albumin-adjusted serum calcium level of 2.6 mmol/L. […] The diagnosis of PHPT will be confirmed by secondary care specialists who at diagnosis should assess symptoms and comorbidities including cardiovascular risk; measure estimated glomerular filtration rate (eGFR) or serum creatinine; do a dual-energy X-ray absorptiometry (DXA) scan of the lumbar spine, distal radius, and hip; and, do an ultrasound scan of the renal tract. […] Further monitoring may be required in primary care. Patients who have had successful parathyroid surgery require their albumin-adjusted serum calcium to be measured once a year, and if abnormal then the diagnostic pathway detailed above should be followed. […] Patients who have not had parathyroid surgery or whose surgery has been unsuccessful require additional monitoring. Their albumin-adjusted serum calcium and eGFR or serum creatinine should be measured once a year, unless the patient is taking cinacalcet.

• #1 Laboratory Diagnosis of Primary Hyperparathyroidism. – Archives of Endocrinology and Metabolism

  https://www.aem-sbem.com/article/laboratory-diagnosis-of-primary-hyperparathyroidism/

  Laboratory Diagnosis of Primary Hyperparathyroidism. […] Increased serum calcium levels may be considered as a potential marker for parathyroid autonomy and this explains why PHP should be routinely investigated in whoever presents with hypercalcemia. […] High or inappropriately normal PTH levels in the presence of hypercalcemia are very suggestive of PHP. […] On the other hand, PHP is very unlikely in the absence of hypercalcemia. […] In short, measuring serum calcium and PTH should be enough for the diagnosis of PHP. […] To further evaluate a patient with PHP and its potential bone and renal complications, one can order other exams such as evaluation of renal function, daily urinary calcium excretion, renal ultrassonography and bone densitometry. These exams may be useful to help the physician decide whether surgery should be indicated or not.

• #2 Hyperparathyroidism | AAFP

  https://www.aafp.org/pubs/afp/issues/2004/0115/p333.html

  Primary hyperparathyroidism is the most frequent cause of hypercalcemia in ambulatory patients. […] Persistent hypercalcemia and an elevated serum parathyroid hormone level are the diagnostic criteria for primary hyperparathyroidism. […] Primary hyperparathyroidism usually is easily distinguishable from malignancy, which is the second most common cause of hypercalcemia. Laboratory measurements of the mediators of calcium metabolism are reliable and facilitate determination of etiologic factors in almost all patients with hypercalcemia. […] Persistent hypercalcemia and an elevated serum PTH level confirm the diagnosis of primary hyperparathyroidism. […] Further laboratory testing is unnecessary because other causes of hypercalcemia rarely are associated with elevated PTH levels. […] Hypercalcemia should be confirmed by repeated measurements of serum calcium concentrations, because all patients with primary hyperparathyroidism do not have demonstrable hypercalcemia every time the serum calcium level is measured.

• #2 Diagnosing Hyperparathyroidism | NYU Langone Health

  https://nyulangone.org/conditions/hyperparathyroidism/diagnosis

  NYU Langone endocrinologists can quickly diagnose the specific type of hyperparathyroidism. […] Your doctor performs a physical exam and several tests to diagnose and determine the cause of hyperparathyroidism. […] Blood tests are very effective in determining the type of hyperparathyroidism. Your doctor may order tests that measure calcium, parathyroid hormone, and vitamin D levels. […] Kidney function tests can help doctors assess how well the kidneys are working. These can also reveal if any dysfunction is causing the excessive production of parathyroid hormone. The results of these tests help your doctor to diagnose the specific type of hyperparathyroidism and determine the best treatment. […] Your endocrinologist may order one of several studies to identify the overactive parathyroid gland, particularly if surgery may be indicated.

• #2 Hyperparathyroidism

  https://www.nhs.uk/conditions/hyperparathyroidism/

  Hyperparathyroidism is where the parathyroid glands (in the neck, near the thyroid gland) produce too much parathyroid hormone. […] A diagnosis may be missed or delayed because there are no symptoms or they are vague, like feeling tired, and thought to be caused by another condition. […] It’s important that hyperparathyroidism is diagnosed as soon as possible. Without treatment, it can gradually get worse and may lead to complications. […] Hyperparathyroidism is diagnosed after a blood test shows: high levels of parathyroid hormone; high levels of blood calcium, often with low levels of phosphorus. […] A DEXA scan (a bone density X-ray) can help detect bone loss, fractures or bone softening, and X-rays, CT scans or ultrasound scans may show calcium deposits or kidney stones.

• #2 Hyperparathyroidism Diagnosis for Parathyroid Disease | Dr. Larian

  https://www.hyperparathyroidmd.com/diagnosis/

  If the blood test indicates excessive calcium in the blood AND a high level of PTH (not a suppressed parathyroid gland), Dr. Larian can draw the conclusion that the parathyroid gland is not functioning properly and HPT is present. […] The most important thing to understand in terms of diagnosing hyperparathyroid disease is that just because you don’t have the “normal” presentation of the disease does not mean you do not have parathyroid disease! Every patient has a unique presentation of the disease and should be evaluated on an individualized basis. You do not need to have both high PTH and high calcium levels in order to have the disease.

• #2 Hyperparathyroidism – Endocrine and Metabolic Disorders – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/endocrine-and-metabolic-disorders/parathyroid-disorders/hyperparathyroidism

  Hyperparathyroidism occurs when one or more of the parathyroid glands become overactive, causing elevated serum levels of parathyroid hormone and leading to hypercalcemia. […] Diagnosis is with serum levels of calcium and parathyroid hormone. […] The diagnosis of primary hyperparathyroidism should be made based on blood and urine tests and clinical findings. […] A diagnosis of hyperparathyroidism is usually first suspected when elevated serum calcium is found on routine blood tests. […] If calcium remains high on repeat testing, intact PTH should be checked and interpreted with the calcium level. […] Patients with primary hyperparathyroidism have a high PTH concentration in the absence of hypocalcemia. […] Low serum phosphate concentration suggests hyperparathyroidism, especially when coupled with elevated renal excretion of phosphate.

• #2 Hyperparathyroidism Diagnosis for Parathyroid Disease | Dr. Larian

  https://www.hyperparathyroidmd.com/diagnosis/

  Dr. Larian will order the following laboratory tests to help him diagnose hyperparathyroid disease: Blood calcium and ionized calcium on two separate occasions (which can be done as little as one week apart), PTH (intact) levels on two separate occasions (which can be done as little as one week apart), Vitamin D levels, specifically 25 (OH) Vitamin D and 1,25 (OH) vitamin D, Magnesium and phosphorus levels (to see the chemical balance in the body), Basic chemistry and creatinine levels (to assess kidney function), Alkaline phosphatase (to check if bone disease is causing the calcium level to rise or the impact of hyperparathyroidism on the bones), 24-hour urine calcium and creatinine to assess the degree of calcium loss in the kidneys and help identify familial hypocalciuric hypercalcemia.

• #2 Hyperparathyroidism – Wikipedia

  https://en.wikipedia.org/wiki/Hyperparathyroidism

  The diagnosis of primary hyperparathyroidism is made by finding elevated calcium and PTH in the blood. […] The gold standard of diagnosis is the PTH immunoassay. Once an elevated PTH has been confirmed, the goal of diagnosis is to determine the type of hyperparathyroidism (primary, secondary, or tertiary hyperparathyroidism) by obtaining a serum calcium, phosphate, and PTH levels. […] Primary hyperparathyroidism has high calcium, vitamin D, and PTH levels and a low phosphate level. […] Secondary hyperparathyroidism has low serum calcium and vitamin D levels, and high phosphate and PTH levels. […] Tertiary hyperparathyroidism has high serum calcium, phosphate, and PTH and low vitamin D levels. […] Hyperparathyroidism can cause hyperchloremia and increase renal bicarbonate loss, which may result in a normal anion gap metabolic acidosis.

• #2 Hyperparathyroidism: What It Is, Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/14454-hyperparathyroidism

  Tests providers use to diagnose and monitor hyperparathyroidism include: Blood tests. 24-hour urine test. For this test, you collect your pee for 24 hours and then bring it to a lab for testing. Your provider will give you instructions on how to complete a 24-hour urine test. Parathyroid scan. Also called a sestamibi scan, providers can use a parathyroid scan to help locate which gland or glands are producing too much PTH. Before surgery, they may use the scan to locate specific areas to remove. […] The type of treatment depends on whether you have primary or secondary hyperparathyroidism. Treatments could include surgery, supplements and/or lifestyle changes. […] Surgery to remove a growth or an enlarged parathyroid gland (parathyroidectomy) can cure hyperparathyroidism. […] If you have hyperparathyroidism and dont have surgery, youll need to monitor your symptoms. You might also need to make changes to what you eat or take medications or supplements.

• #2 Laboratory Diagnosis of Primary Hyperparathyroidism. – Archives of Endocrinology and Metabolism

  https://www.aem-sbem.com/article/laboratory-diagnosis-of-primary-hyperparathyroidism/

  Laboratory Diagnosis of Primary Hyperparathyroidism. […] Increased serum calcium levels may be considered as a potential marker for parathyroid autonomy and this explains why PHP should be routinely investigated in whoever presents with hypercalcemia. […] High or inappropriately normal PTH levels in the presence of hypercalcemia are very suggestive of PHP. […] On the other hand, PHP is very unlikely in the absence of hypercalcemia. […] In short, measuring serum calcium and PTH should be enough for the diagnosis of PHP. […] To further evaluate a patient with PHP and its potential bone and renal complications, one can order other exams such as evaluation of renal function, daily urinary calcium excretion, renal ultrassonography and bone densitometry. These exams may be useful to help the physician decide whether surgery should be indicated or not.

• #2 Parathyroid Tumors (Primary Hyperparathyroidism) | Memorial Sloan Kettering Cancer Center

  https://www.mskcc.org/cancer-care/types/head-neck/parathyroid-tumors-primary-hyperparathyroidism

  Once a diagnosis is made, imaging tests help doctors determine which gland or glands are causing the problem. Between 10 and 20 percent of people with primary hyperparathyroidism have more than one abnormal parathyroid gland. […] Imaging tests that doctors might recommend include: a CT scan, an ultrasound, a sestamibi scan, venous sampling (this is used in rare situations when the parathyroid tumor is difficult to locate or the patient has already had a parathyroid surgery). […] The combination of calcium and parathyroid hormone levels will guide your doctor in diagnosing an overactive parathyroid gland.

• #2 Hyperparathyroidism (primary) NICE guideline: diagnosis, assessment, and initial management

  https://pmc.ncbi.nlm.nih.gov/articles/PMC7319687/

  The guideline advises referral to a specialist with expertise in PHPT if a patients PTH measurement is: above the midpoint of the reference range and PHPT is suspected; or below the midpoint of the reference range with a concurrent albumin-adjusted serum calcium level of 2.6 mmol/L. […] The diagnosis of PHPT will be confirmed by secondary care specialists who at diagnosis should assess symptoms and comorbidities including cardiovascular risk; measure estimated glomerular filtration rate (eGFR) or serum creatinine; do a dual-energy X-ray absorptiometry (DXA) scan of the lumbar spine, distal radius, and hip; and, do an ultrasound scan of the renal tract. […] Further monitoring may be required in primary care. Patients who have had successful parathyroid surgery require their albumin-adjusted serum calcium to be measured once a year, and if abnormal then the diagnostic pathway detailed above should be followed. […] Patients who have not had parathyroid surgery or whose surgery has been unsuccessful require additional monitoring. Their albumin-adjusted serum calcium and eGFR or serum creatinine should be measured once a year, unless the patient is taking cinacalcet.

• #2 Primary hyperparathyroidism – Symptoms, diagnosis and treatment | BMJ Best Practice US

  https://bestpractice.bmj.com/topics/en-us/133

  Primary hyperparathyroidism is confirmed biochemically with synchronous elevation of serum calcium and inappropriate elevation of parathyroid hormone (PTH). […] An elevated serum calcium level with a higher or inappropriately normal (i.e., non-suppressed) plasma PTH level confirms a diagnosis of PHPT. […] Normocalcemic PHPT is recognized as a variant of PHPT. It is characterized by persistently high levels of parathyroid hormone in the setting of normal serum and ionized calcium levels, after secondary causes of PTH elevation have been excluded. […] The clinical features of normocalcemic PHPT can be similar to the classical form, including nephrolithiasis and low bone mineral density. […] Key diagnostic factors include incidental finding on biochemical testing, history of osteoporosis or osteopenia, family history of hyperparathyroidism or features suggestive of hypercalcemia, and nephrolithiasis.

• #2 Normocalcemic Primary Hyperparathyroidism – Endocrine Surgery | UCLA Health

  https://www.uclahealth.org/medical-services/surgery/endocrine-surgery/conditions-treated/parathyroid/normocalcemic-primary-hyperparathyroidism

  After vitamin D supplementation, the patients PTH level should return to normal. If calcium levels become high and PTH remains high after Vitamin D supplementation, this establishes the diagnosis of primary hyperparathyroidism. […] Not everyone with normocalcemic primary hyperparathyroidism needs treatment. Many patients can be safely monitored over time. About 15% of people seem to progress to primary hyperparathyroidism and develop high blood calcium levels; these patients ultimately need surgery. […] Our practice is to offer surgery selectively to patients with normocalcemic primary hyperparathyroidism. Currently, less than 1/3 of our patients with nPHPT undergo surgery. The typical patient who undergoes surgery at our center for nPHPT is selected for parathyroid surgery because they have progressive unexplained bone loss. […] Bone loss related to nPHPT may also be treated with medications used to treat osteopenia and osteoporosis.

• #2 Hyperparathyroidism – Rheumatology Advisor

  https://www.rheumatologyadvisor.com/ddi/hyperparathyroidism/

  If a patient is borderline for hyperparathyroidism but has low vitamin D levels, the 25-hydroxyvitamin D level should be raised to at least 30 ng/mL for at least three months in order to rule out vitamin D deficiency. If a patient is taking known hypercalcemic drugs, such as thiazide and lithium, then the regimen should be halted for three to six months, if possible. After the allotted time has passed, retesting of serum calcium and parathyroid hormone levels are needed to help confirm a diagnosis. The clinician can exclude familial hypocalciuric hypercalcemia with a 24-hour urine calcium determination (100 mg calcium/24 hours) or by a low calcium/creatinine excretion ratio, typically less than .02. Familial hypocalciuric hypercalcemia may present as early as age 30, but essentially never after age 50.

• #2 Primary Hyperparathyroidism | Endocrine Society

  https://www.endocrine.org/patient-engagement/endocrine-library/primary-hyperparathyroidism

  Primary hyperparathyroidism (PHPT) is a condition in which one (or more) of your parathyroid glands produces too much parathyroid hormone and releases it in the bloodstream, often leading to high calcium levels. […] Health care providers most often diagnose PHPT with blood tests that detect high calcium and PTH levels. […] When PHPT is found, further tests may be done to check for complications, including: […] In some cases, patients also receive testing for genetic forms of the condition. […] It has been hypothesized that taking low (not enough) calcium for a long time may increase the risk of developing PHPT by causing chronic stimulation of the parathyroid gland. […] The doctor chooses a treatment based on a patients age, test results, and which signs or symptoms are present. […] Surgical removal of adenomas or enlarged parathyroid glands is recommended for all patients under the age of 50, whether or not they have symptoms.

• #2 Recommendations | Hyperparathyroidism (primary): diagnosis, assessment and initial management | Guidance | NICE

  https://www.nice.org.uk/guidance/ng132/chapter/recommendations

  Measure albumin-adjusted serum calcium for people with any of the following features, which might indicate primary hyperparathyroidism: […] Measure parathyroid hormone (PTH) for people whose albumin-adjusted serum calcium level is either: […] For people with a confirmed diagnosis of primary hyperparathyroidism: […] Refer people with a confirmed diagnosis of primary hyperparathyroidism to a surgeon with expertise in parathyroid surgery if they have: […] Offer preoperative imaging (usually ultrasound) to people having surgery for primary hyperparathyroidism if it will inform the surgical approach. […] For people who have had unsuccessful surgery for primary hyperparathyroidism: […] Offer monitoring to all people diagnosed with primary hyperparathyroidism, as set out in table 1. […] Offer parathyroid surgery to women who have primary hyperparathyroidism and are considering pregnancy. […] Give people with primary hyperparathyroidism information about the condition, including: […] Discuss ongoing care and monitoring for primary hyperparathyroidism, explaining the type and frequency of monitoring that will be offered and the purpose of each.

• #2 Evolution of the Diagnosis and Treatment of Primary Hyperparathyroidism

  https://www.mdpi.com/2077-0383/12/5/2057

  Pre-operative localization of the pathological parathyroid gland is essential to permit a minimally invasive procedure; otherwise bilateral neck exploration is necessary. […] The improvement in diagnostic tools makes the minimally-invasive approach the technique of choice when localization is well-defined. […] In our Department, US combined to [99mTc]Tc-MIBI scintigraphy continue to be the gold standard for localization of parathyroid adenomas. […] In case of doubtful or negative localization and in case of suspected hyperplasia or multiglandular adenomas, additional imaging as [18F] fluorocholine PET/CT. […] A helpful solution in this tricky situation is ICG fluorescence angiography, which should be considered as an adjunctive localization method during parathyroid surgery. […] Furthermore, the intraoperative PTH-assay (Io-PTH assay) should be employed to confirm the excision of the pathological parathyroid tissue.

• #2 Hyperparathyroidism (primary) NICE guideline: diagnosis, assessment, and initial management | British Journal of General Practice

  https://bjgp.org/content/70/696/362

  assess symptoms and comorbidities including cardiovascular risk; […] measure estimated glomerular filtration rate (eGFR) or serum creatinine; […] do a dual-energy X-ray absorptiometry (DXA) scan of the lumbar spine, distal radius, and hip; and, […] do an ultrasound scan of the renal tract. […] Surgical management is the primary treatment option. […] Further monitoring may be required in primary care. […] Patients who have had successful parathyroid surgery require their albumin-adjusted serum calcium to be measured once a year, and if abnormal then the diagnostic pathway detailed above should be followed. […] A specialist opinion should be sought for the monitoring of patients who have osteoporosis or renal stones, and a specialist endocrine opinion should be sought for the monitoring of patients who have had parathyroid surgery for multi-gland disease or have disease that recurs after successful surgery. […] Patients who have not had parathyroid surgery or whose surgery has been unsuccessful require additional monitoring.

• #2 How to Diagnose Hyperparathyroidism: Easy Step by Step Diagnosis of Primary Hyperparathyroidism.

  https://www.parathyroid.com/diagnosis.htm

  Since parathyroid glands are glands within the endocrine system, we can detect parathyroid disease by measuring the hormone that the parathyroid glands make and compare this level to the amount of calcium in the blood. […] A person with a high blood calcium that has a high parathyroid hormone level at the same time–almost surely has a bad parathyroid gland. Informed doctors should be able to make the diagnosis of hyperparathyroidism if the calcium is high and the PTH level is high at the same time. […] However… many people (about 20% of all patients with hyperparathyroidism) will have parathyroid disease (caused by a parathyroid tumor) when they have high calcium and NORMAL PTH levels… The point here is that the parathyroid gland is still the problem. […] It is extremely rare for people to have high calcium levels in their blood… and not have a parathyroid tumor. If you have high calcium in your blood, chances are extremely high you have hyperparathyroidism, unless your PTH is VERY low.

• #2

  https://link.springer.com/article/10.1007/s00198-016-3716-2

  The combination of hypercalcemia and an elevated or inappropriately normal parathyroid hormone (PTH) level makes PHPT the most likely diagnosis. […] The differential diagnosis of hypercalcemia includes conditions which mimic PHPT, including familial hypocalciuric hypercalcemia (FHH) and certain medication use, such as hydrochlorothiazide or lithium. […] Patients with symptomatic PHPT as well as asymptomatic patients who meet any one of the guideline criteria should be advised to undergo PTx, unless contraindications exist. […] Surgical consultation can be offered to those who do not meet guidelines for surgery. […] In asymptomatic PHPT, the value of PTx is emphasized, as surgery corrects the underlying abnormality and improves BMD, lowers bone turnover, and improves fracture-free survival. […] Monitoring appears to be a safe option for possibly up to 8 to 10 years for patients with asymptomatic PHPT who do not meet guidelines for surgery or are unable or unwilling to undergo PTx.

• #3 Primary Hyperparathyroidism diagnosis

  https://www.hyperparathyroiduk.com/about-phpt-symptoms

  Parathyroid hormone should be tested in EDTA to ensure stability and accurate results. […] Symptoms of PHPT can vary. For many they become worse due to the length of time left untreated. […] By the time many people are diagnosed due to symptoms, they will have had PHPT for some time. […] Studies describe symptoms presenting from five years before a biochemical diagnosis. […] We conducted a survey to ask members if they had been diagnosed coincidentally or from symptoms. […] If doctors were more aware of symptoms attributed to PHPT, they might be able to diagnose it sooner. […] Many UK GP’s and endocrinologists are described as the brick wall or unrelenting gatekeeper to surgical referral. […] Many are letting down their patients due to poor knowledge of primary hyperparathyroidism.

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