Internal Medicine

0521779407-17 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 21:19

Primary Hyperparathyroidism 1213

Imaging

■Sestamibi scanning sensitive and specific in localizing abnormal

parathyroid gland(s)

■Bone densitometry to assess effects on bone mineral (spine, hip,

radius)

■Nephrocalcinosis on abdominal X-ray

differential diagnosis

■Hypercalcemia of malignancy

■Familial benign hypercalcemia (FBH)

■Granulomatous disease

■Thyrotoxicosis

■Vitamin A or D toxicity

■Lithium or thiazide therapy

management

What to Do First

■Determine if symptomatic or asymptomatic

■If asymptomatic, rule out FBH

General Measures

■Assess symptoms and end-organ complications (renal, bone, psy-

chological, gastrointestinal)

■If complications present, consider surgery

■If symptomatic, refer to endocrine surgeon

■If hypercalcemic crisis present (rare, <10% of patients):

➣Urgent volume expansion

➣Loop diuretics

➣IV bisphosphonates

➣Refer for surgery

specific therapy

■May be followed, if asymptomatic

■If symptomatic, end-organ complications or young (<age 50), refer

to endocrine surgeon

Guidelines from NIH Consensus on Management of Primary HPTH

(2002)

■If symptoms present, operate

■Consider surgery if:

➣Age < 50

➣U-Ca > 400 mg/24 h

➣Serum Ca 1 mg/dl above upper limit of normal