Summary
Definition
History and exam
Key diagnostic factors
- incidental finding on biochemical testing
- history of osteoporosis or osteopenia
- family history of hyperparathyroidism or features suggestive of hypercalcemia
- nephrolithiasis
Other diagnostic factors
- poor sleep
- fatigue
- myalgia
- anxiety
- depression
- memory loss
- overt neuromuscular dysfunction
- cardiovascular and metabolic dysfunction
- features suggestive of hypercalcemia
- hard and dense neck mass
Risk factors
- female sex
- age ≥50-60 years
- family history of PHPT
- multiple endocrine neoplasia (MEN) 1, 2A, or 4
- current or historical lithium treatment
- hyperparathyroidism-jaw tumor syndrome
- history of head and neck irradiation
Diagnostic investigations
1st investigations to order
- serum calcium
- serum intact PTH with immunoradiometric or immunochemical assay
Investigations to consider
- 25-hydroxyvitamin D level
- serum alkaline phosphatase
- serum phosphorus
- 24-hour urinary calcium
- dual-energy x-ray absorptiometry (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
Emerging tests
- radiolabeled choline PET
Treatment algorithm
asymptomatic with surgical indications or symptomatic
asymptomatic with no surgical indications
Contributors
Authors
John Ayuk, MD
Consultant Endocrinologist
University Hospitals Birmingham
Birmingham
UK
Disclosures
JA declares that he has no competing interests.
Neil Gittoes, MD, PhD
Consultant Endocrinologist and Honorary Professor of Endocrinology
Associate Medical Director
University Hospitals Birmingham
Birmingham
UK
Disclosures
NG has contributed to advisory boards for Takedo and Shire pharmaceuticals.
Acknowledgements
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 topic. FP, SG, and NDP declare that they have no competing interests.
Peer reviewers
Bridget Sinnott, MD
Clinical Assistant
Professor of Medicine
University of Illinois at Chicago
Chicago
IL
Disclosures
BS declares that she has no competing interests.
Udaya Kabadi, MD
Professor of Medicine
Department of Internal Medicine
University of Iowa
Iowa City
IA
Disclosures
UK declares that she has no competing interests.
Leonard Egede, MD
Professor of Medicine
Medical University of South Carolina
Charleston
SC
Disclosures
LE declares that he has no competing interests.
Petros Perros, BSc, MBBS, MD, FRCP
Department of Endocrinology
Elliott Building
Royal Victoria Infirmary
Newcastle-upon-Tyne
UK
Disclosures
PP declares that he has no competing interests.
Differentials
- Familial hypocalciuric hypercalemia (FHH)
- Humoral hypercalcemia of malignancy
- Multiple myeloma
More DifferentialsGuidelines
- Practice parameter for the performance and interpretation of diagnostic ultrasound of the thyroid and extracranial head and neck
- The EANM practice guidelines for parathyroid imaging
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