Last reviewed: November 2017
Last updated: October  2017

Summary

Definition

History and exam

Key diagnostic factors

  • family history of hyperparathyroidism or features suggestive of hypercalcemia
  • nephrolithiasis
  • history of osteoporosis or osteopenia

Other diagnostic factors

  • bone pain
  • poor sleep
  • fatigue
  • anxiety
  • depression
  • memory loss
  • myalgias
  • paresthesias
  • muscle cramps
  • constipation
  • overt neuromuscular dysfunction
  • unsteady gait
  • abdominal pain
  • hard and dense neck mass

Risk factors

  • history of head and neck irradiation
  • female gender
  • age 50 to 60 years
  • family history of PHPT
  • multiple endocrine neoplasia (MEN) 1, 2A, or 4
  • current or historical lithium treatment
  • hyperparathyroid-jaw tumor syndrome

Diagnostic investigations

1st investigations to order

  • serum calcium
  • serum intact PTH with immunoradiometric or immunochemical assay
Full details

Investigations to consider

  • 25-hydroxyvitamin D level
  • serum alkaline phosphatase
  • serum phosphorus
  • 24-hour urinary calcium
  • DXA scan
  • trabecular bone score
  • Tc-99m sestamibi scanning and ultrasonography
  • single photon emission CT + sestamibi scanning
  • CT neck
  • 4-Dimensional (4D) CT neck
  • MRI neck
Full details

Treatment algorithm

Contributors

Authors VIEW ALL

Consultant Endocrinologist

Service Lead for Endocrinology

University Hospitals Birmingham

Birmingham

UK

Disclosures

JA declares that he has no competing interests.

Consultant Endocrinologist and Honorary Professor of Endocrinology

Associate Medical Director

University Hospitals Birmingham

Birmingham

UK

Disclosures

NG declares that he has no competing interests.

Dr John Ayuk and Professor Neil Gittoes would like to gratefully acknowledge Dr Fausto Palazzo, Dr Swaroop Gantela, and Dr Nancy D. Perrier, the previous contributors to this monograph. FP, SG, and NDP declare that they have no competing interests.

Peer reviewers VIEW ALL

Clinical Assistant

Professor of Medicine

University of Illinois at Chicago

Chicago

IL

Disclosures

BS declares that she has no competing interests.

Professor of Medicine

Department of Internal Medicine

University of Iowa

Iowa City

IA

Disclosures

UK declares that she has no competing interests.

Professor of Medicine

Medical University of South Carolina

Charleston

SC

Disclosures

LE declares that he has no competing interests.

Department of Endocrinology

Elliott Building

Royal Victoria Infirmary

Newcastle-upon-Tyne

UK

Disclosures

PP declares that he has no competing interests.

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