DIAGNOSIS
Diagnosing primary hyperparathyroidism involves a combination of clinical evaluation, laboratory tests, and imaging studies. Diagnostic steps may include:
- Serum Calcium Levels: Measurement of serum calcium levels, including total calcium and ionized calcium, to assess for hypercalcemia.
- Parathyroid Hormone (PTH) Levels: Measurement of serum PTH levels to confirm excessive PTH secretion and assess for inappropriately elevated or normal PTH levels relative to calcium.
- Calcium/Creatinine Ratio: Calculation of the calcium/creatinine ratio in a spot urine sample to assess for increased urinary calcium excretion.
- Imaging Studies: Imaging modalities such as neck ultrasound, sestamibi scan (parathyroid scintigraphy), or magnetic resonance imaging (MRI) may be performed to localize parathyroid adenomas or hyperplastic glands.
TREATMENT
Treatment of primary hyperparathyroidism depends on the severity of symptoms, the presence of complications, and the underlying cause. Treatment options may include:
- Observation: Observation and monitoring may be appropriate for individuals with mild or asymptomatic hypercalcemia and no evidence of complications or progressive disease.
- Surgical Intervention: Parathyroidectomy (surgical removal of the affected parathyroid gland or glands) may be recommended for individuals with symptomatic or severe primary hyperparathyroidism, complications such as kidney stones or osteoporosis, or significantly elevated serum calcium levels.
- Medical Management: Medical therapy with calcimimetic agents (e.g., cinacalcet) may be considered as adjunctive therapy to lower serum calcium levels and reduce PTH secretion in individuals who are not candidates for surgery or have persistent hypercalcemia following surgery.
