Primary Hyperparathyroidism

Manage Asymptomatic Primary Hyperparathyroidism:

  • Surgery (parathyroidectomy) when one or more of the following criteria is met:
    • Increase in serum calcium level > 1mg/dL above upper limit of normal.
    • Creatinine clearance must be <60 ml/min.
    • DEXA scan (T-score) of -2.5 or worse (lumbar spine, total hip, femoral neck, distal radius).
    • Age 50 years or younger.
  • If criteria for surgery is NOT met:
    • Surveillance is recommended:
      • Annual measurement of serum calcium and creatinine levels
      • DEXA scan every 1-2 years (DEXA scan frequency increased to yearly when any treatment has been initiated for bone health or other medications have been started that may affect bone health).
    • Other precautions to prevent disease-related complications:
      • Adequate Vitamin D (400-600 U daily) intake to prevent further PTH stimulation.
        • Replete Vitamin D if deficit.
      • Adequate physical activity to prevent bone resorption.
      • Adequate hydration to prevent kidney damage

Bisphosphates, decrease dietary calcium to <400mg/day, drink 2-3L water per day, and administer phosphate replacement

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