Summary
Definition
History and exam
Key diagnostic factors
- hallazgo incidental en las pruebas bioquímicas
- antecedentes de osteoporosis u osteopenia
- antecedentes familiares de hiperparatiroidismo o características que indican hipercalcemia
- nefrolitiasis
Other diagnostic factors
- trastornos del sueño
- fatiga
- mialgia
- ansiedad
- depresión
- pérdida de la memoria
- disfunción neuromuscular evidente
- disfunción cardiovascular y metabólica
- síntomas gastrointestinales
Risk factors
- sexo femenino
- ≥50-60 años de edad
- neoplasia endocrina múltiple (MEN) 1, 2A o 4
- tratamiento con litio previo o actual
- síndrome de hiperparatiroidismo por tumor maxilar
- antecedentes familiares de HPTP
- antecedentes de irradiación de cabeza o cuello.
Diagnostic investigations
1st investigations to order
- calcio sérico
- PTH intacta sérica con ensayo inmunoquímico o inmunoradiométrico
Investigations to consider
- nivel de 25-hidroxivitamina D
- fosfatasa alcalina en suero
- fósforo sérico
- calciuria de 24 horas
- exploración por radioabsorciometría de doble energía (DEXA)
- puntaje óseo trabecular
- ecografía de cuello
- exploración con tecnecio-99m sestamibi
- TC de emisión monofotónica (SPECT)
- TC de cuello
- TC cuatridimensional (4D) del cuello
- IRM de cuello
Emerging tests
- colina radiomarcada PET
- aprendizaje automático para identificar el hiperparatiroidismo primario
Treatment algorithm
asintomático sin indicaciones quirúrgicas o sintomático
asintomático sin indicaciones quirúrgicas
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 is an author of several references cited in this topic and is a member of the 2021 European Society of Endocrinology Educational Program of Parathyroid Disorders (PARAT) Working Group.
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
Brendan C. Stack Jr, MD, FACS, FACE
Chairman, Endocrine Surgery Section
American Head and Neck Society
Professor and former inaugural Chairman
Department of Otolaryngology-Head and Neck Surgery
Southern Illinois University School of Medicine
Springfield
IL
Disclosures
BCS 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.
Peer reviewer acknowledgements
BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.
Disclosures
Peer reviewer affiliations and disclosures pertain to the time of the review.
References
Key articles
Bilezikian JP, Khan AA, Silverberg SJ, et al. Evaluation and management of primary hyperparathyroidism: summary statement and guidelines from the fifth International Workshop. J Bone Miner Res. 2022 Nov;37(11):2293-314.Full text Abstract
Wilhelm SM, Wang TS, Ruan DT, et al. The American Association of Endocrine Surgeons guidelines for definitive management of primary hyperparathyroidism. JAMA Surg. 2016 Oct 1;151(10):959-68.Full text Abstract
Bollerslev J, Rejnmark L, Zahn A, et al. European expert consensus on practical management of specific aspects of parathyroid disorders in adults and in pregnancy: recommendations of the ESE educational program of parathyroid disorders. Eur J Endocrinol. 2022 Feb 1;186(2):R33-63.Full text Abstract
Walker MD, Silverberg SJ. Primary hyperparathyroidism. Nat Rev Endocrinol. 2018 Feb;14(2):115-25.Full text Abstract
Petranović Ovčariček P, Giovanella L, Carrió Gasset I, et al. The EANM practice guidelines for parathyroid imaging. Eur J Nucl Med Mol Imaging. 2021 Aug;48(9):2801-2822.Full text Abstract
Reference articles
A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
Diagnósticos diferenciais
- Hipercalcemia hipocalciúrica familiar (FHH)
- Hipercalcemia humoral de neoplasia maligna
- Mieloma múltiple
Mais Diagnósticos diferenciaisDiretrizes
- European expert consensus on practical management of specific aspects of parathyroid disorders in adults and in pregnancy
- Practice parameter for the performance and interpretation of diagnostic ultrasound of the thyroid and extracranial head and neck
Mais Diretrizes
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