Hyperparathyroidism

Diagnosis of PHPT

Diagnosis is based on laboratory tests showing elevated calcium and PTH levels. Confirmatory tests are essential, as calcium levels may fluctuate.

Treatment of PHPT

1. Surgery:

• Indications for Surgery:

  • Serum calcium >1.0 mg/dL above the upper limit of normal
  • 24-hour urinary calcium >400 mg
  • Reduced creatinine clearance
  • Bone mineral density T-score <−2.5
  • Age <50
  • Patient preference for definitive treatment

• Types of Surgery:

  • Minimally Invasive Parathyroidectomy: Outpatient procedure with small incision.
  • Standard Neck Exploration: Larger incision to examine and remove overactive glands.

Surgery has a high success rate when performed by experienced endocrine surgeons. It can lead to improved bone density, fewer fractures, and reduced kidney stones.

2. Monitoring:

• For asymptomatic patients with mild conditions, regular monitoring may be sufficient.
• Includes annual serum calcium and creatinine measurements and bone density tests every 1 to 2 years.
• Adequate hydration, regular exercise, and avoidance of certain diuretics are recommended.

3. Medications:

• Calcimimetics (Cinacalcet): Approved for managing hypercalcemia associated with PHPT.
• Bisphosphonates and Selective Estrogen Receptor Modulators: Under study for potential benefits.

4. Diet and Nutrition:

• Vitamin D deficiency should be corrected to maintain serum levels above 20 ng/dL.
• No need to restrict dietary calcium for asymptomatic patients under monitoring.
• Post-surgery patients with hypocalcemia need lifelong calcium and vitamin D supplementation.

By addressing the underlying cause, using appropriate surgical interventions, and monitoring, hyperparathyroidism can be effectively managed.