BMJ Best Practice Podcast Primary hyperparathyroidism
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Sep 11, 2023 Primary hyperparathyroidism is a common disorder affecting both men and women. The podcast discusses the diagnosis and management of the condition, including surgery and medication. It also covers the indications for surgery, the use of bisphosphonates, and the challenges in diagnosing symptoms and potential complications. The causes and management of primary hyperparathyroidism, as well as addressing patient questions, are also explored.
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Key Workup Beyond Bloods
- Support diagnosis with 24-hour urinary calcium and neck ultrasound to localise abnormal glands.
- Perform DEXA and renal ultrasound to screen for osteoporosis and kidney stones as complications.
Main Differentials For Hypercalcemia
- The two main causes of hypercalcemia are primary hyperparathyroidism and cancer, distinguishable by PTH level.
- Familial hypocalciuric hypercalcemia mimics higher calcium with low urinary calcium and a family history.
Rule Out Familial Causes
- When hypercalcemia is found, always measure PTH and urinary calcium to exclude familial hypocalciuric hypercalcemia.
- Ask about family history because relatives may report persistent high calcium despite surgery.