AAES PARATHYROIDECTOMY GUIDELINES 1:

DIAGNOSIS AND EVALUATION

 

 

RECOMMENDATION: The biochemical evaluation of suspected pHPT should include serum total calcium, PTH, creatinine, and 25-OH vitamin D levels.

 

COMMENT: The diagnosis of primary hyperparathyroidism (pHPT) is made on the basis of serum calcium and PTH levels with the common causes of secondary HPT, Vitamin D deficiency and kidney failure, needing to be excluded.

 

RECOMMENDATION: A 24-hour urine measurement of calcium and creatinine should be obtained in patients undergoing evaluation for possible pHPT.

 

COMMENT: This is done to exclude the rare genetic disorder of familial hypocalciuric hypercalcaemia (FHH) which can mimic pHPT

 

RECOMMENDATION: In patients with suspected pHPT, a personal and family history should be performed.

 

COMMENT: A family history of pHPT can be associated with multiple glands being involved whereas exposure to ionizing radiation is a risk factor for parathyroid tumours

 

RECOMMENDATION: In patients with asymptomatic pHPT, abdominal imaging should be considered for detection of nephrocalcinosis or nephrolithiasis

 

COMMENT: pHPT can cause silent kidney stones which needs to be checked

 

RECOMMENDATION: Bone mineral density should be measured at the lumbar spine, hip, and distal radius for patients with pHPT, preferably using dual-energy X-ray absorptiometry (DXA).

 

COMMENT: The commonest end organ damage from pHPT is loss of bone mineral,  leading to osteoporosis and this needs to be checked

 

RECOMMENDATION: Genetic counseling and testing should be performed for patient <40 years of age with pHPT and MGD.

 

COMMENT: Young patients with  strong suspicion of an underlying genetic disorder (ie multiple glands involved at operation or a positive family history) should undergo gene testing, however most young patients and children with pHPT still just have sporadic disease and gene testing is only rarely performed prior to surgery in Australia.