Diagnosis of primary hyperparathyroidism: controversies, practical issues and the need for Australian guidelines

Abstract

Primary hyperparathyroidism (PHPT) is one of the most common endocrine disease processes, however the clinical presentation in 2003 is typically characterized by minimal signs or symptoms of hypercalcaemia or para-thyroid hormone (PTH) excess. Recent developments in imaging and management of PHPT have been published, however the area of biochemical investigation has been relatively neglected. A group of experts convened in April 2002 to consider whether changes were needed to the 1990 consensus guidelines which defined criteria for the diagnosis and management of asymptomatic PHPT. It is appropriate to review the revised recommendations, which have been disseminated by the panel and were recently published. Each of the laboratory -analytes used to establish the diagnosis of PHPT and exclude alternative diagnoses or complications will be considered in succession in this review: (i) calcium, (ii) intact PTH, (iii) urinary calcium and (iv) 25 hydroxy-vitamin D. Furthermore, critical appraisal of the new diagnostic criteria and their applicability to Australian laboratories will be addressed. Finally, limitations and problems associated with the measurement of each analyte will be reviewed.

Primary hyperparathyroidism is associated with increased circulating bone marrow-derived progenitor cells

“…The patients with PHPT included in the study (15 women and 9 men) were recruited from the Department of Surgery at the Hospital MarthaMaria in Munich, Germany. The inclusion criteria for the PHPT group comprised an increased total serum concentration of calcium (Ͼ2.65 mmol/l), an inappropriately high serum level of PTH (Ͼ67 pg/ml), serum creatinine Ͻ1.3 mg/dl, postoperative normalization of serum calcium, and sonographic and histological confirmation of parathyroid adenoma (3,10). The mean age of the patients was 58.7 Ϯ 17.3 yr (range 26 -80 yr), and their mean total serum calcium concentration was 2.88 Ϯ 0.04 mmol/l before parathyroid surgery.…”

Plasma 25-hydroxyvitamin D, 1,25-dihydroxyvitamin D, and parathyroid hormone in familial hypocalciuric hypercalcemia and primary hyperparathyroidism

“…Vitamin D metabolism has been explored only in a small number of FHH patients (17)(18)(19). We have recently reported on the ability of the calcium/creatinine clearance ratio (CCCR) and other variables of renal calcium excretion to discriminate between FHH and PHPT (20), as described by Marx et al and others (1,(21)(22)(23)(24)(25)(26).…”

Manifestações musculoesqueléticas no hiperparatireoidismo primário

“…1,6,26 However, in the present study, an elevated incidence of musculoskeletal manifestations was observed; more than half of the patients had signs/symptoms of osteoarthritis, one third had diffuse arthralgia, followed by symptoms of fibromyalgia, chondrocalcinosis, and tendinopathies.…”

“…5 Less frequently, an increase in the size of two glands, or even diffuse hyperplasia, 5 is seen, and parathyroid carcinoma is a rare disorder. 4 The majority of the patients have a subtle increase in PTH and calcium levels and they are asymptomatic; 6 consequently, the history and physical exam rarely provide any indications of PHP. In less than half of the cases, PHP can present with different clinical manifestations secondary to hypercalcemia.…”