Last reviewed: 24 Sep 2021
Last updated: 21 Sep 2021

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

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.

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