Primary hyperparathyroidism: Diagnosis, differential diagnosis, and evaluation
- Ghada El-Hajj Fuleihan, MD, MPH
Ghada El-Hajj Fuleihan, MD, MPH
- Professor of Medicine
- American University of Beirut Medical Center, Lebanon
- Shonni J Silverberg, MD
Shonni J Silverberg, MD
- Professor of Medicine
- Columbia University College of Physicians and Surgeons
The diagnosis of hyperparathyroidism is usually first suspected because of the finding of an elevated serum calcium concentration. If hypercalcemia is confirmed on a repeat sample, all of its causes should be considered (table 1). (See "Etiology of hypercalcemia".)
The serum parathyroid hormone (PTH) concentration should then be measured using a two-site immunoradiometric sandwich assay. The diagnosis of primary hyperparathyroidism (PHPT) is usually made by finding a PTH concentration that is frankly elevated or within the normal range but inappropriately normal given the patient's hypercalcemia (figure 1).
The diagnosis, differential diagnosis, and evaluation of PHPT will be discussed here. Other aspects of PHPT are reviewed elsewhere.
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- Diagnostic evaluation
- - Serum calcium
- - Serum PTH
- - 24-hour urinary calcium
- - Serum 25-hydroxyvitamin D
- - Role of genetic testing
- DIFFERENTIAL DIAGNOSIS
- Familial hypocalciuric hypercalcemia
- Normocalcemic primary hyperparathyroidism versus secondary hyperparathyroidism
- ADDITIONAL EVALUATION TO DETERMINE MANAGEMENT
- Urinary calcium excretion
- Serum vitamin D
- Serum creatinine
- Renal imaging
- Bone mineral density
- Assessment for vertebral fracture
- Other tests
- - Biochemical renal stone assessment
- - Serum phosphorus
- - Markers of bone turnover
- - Localization studies
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS