Resumo
Definição
History and exam
Key diagnostic factors
- achado incidental em testes bioquímicos
- história de osteoporose ou osteopenia
- história familiar de hiperparatireoidismo ou características sugestivas de hipercalcemia
- nefrolitíase
Other diagnostic factors
- má qualidade do sono
- fadiga
- mialgia
- ansiedade
- depressão
- perda de memória
- disfunção neuromuscular evidente
- disfunção cardiovascular e metabólica
- sintomas gastrointestinais
Risk factors
- sexo feminino
- idade ≥50-60 anos
- neoplasia endócrina múltipla (NEM) 1, 2A ou 4
- histórico ou tratamento atual com lítio
- síndrome do tumor mandibular hiperparatireoidiano
- história familiar de HPTP
- história de irradiação da cabeça e do pescoço
Diagnostic investigations
1st investigations to order
- cálcio sérico
- paratormônio (PTH) intacto sérico com ensaio imunorradiométrico ou imunoquímico
Investigations to consider
- nível da 25-hidroxivitamina D
- fosfatase alcalina sérica
- fósforo sérico
- cálcio urinário de 24 horas
- exame de absorciometria por dupla emissão de raios X (DEXA)
- escore ósseo trabecular
- ultrassonografia do pescoço
- cintilografia com tecnécio-99m sestamibi
- TC por emissão de fóton único (SPECT)
- tomografia computadorizada (TC) do pescoço
- TC quadridimensional (4D) de pescoço
- ressonância nuclear magnética (RNM) do pescoço
Emerging tests
- PET com colina radiomarcada
- aprendizado de máquina para identificar hiperparatireoidismo primário
Treatment algorithm
assintomático sem indicações cirúrgicas ou sintomático
assintomático sem indicações cirúrgicas
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.
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.
Differentials
- Hipercalcemia hipocalciúrica familiar (HHF)
- Hipercalcemia humoral de malignidade
- Mieloma múltiplo
More DifferentialsGuidelines
- 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
More Guidelines
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