Guidelines for the Management of Asymptomatic Primary Hyperparathyroidism (PHPT)

  • Guidelines for the management of asymptomatic primary hyperparathyroidism (PHPT):
    • Were updated in 2013 by the Fourth International Workshop on Asymptomatic Primary Hyperparathyroidism
  • Indications for surgery include the following:
    • Serum calcium :
      • 1 mg/dL above the upper limit of the reference range
    • Bone mineral density T-score:
      • At or below -2.5 SD (in perimenopausal or postmenopausal women and in men aged 50 years or older):
        • At the lumbar spine, total hip, femoral neck, or distal 1/3 radius
    • Vertebral fracture:
      • As evidenced via radiography or vertebral fracture assessment (VFA)
    • Creatinine clearance of:
      • Less than 60 ml/min
    • Twenty-four–hour urinary calcium excretion:
      • Greater than 400 mg/day and increased stone risk as assessed through biochemical stone risk analysis
    • Presence of nephrolithiasis or nephrocalcinosis as determined using radiography, ultrasonography, or CT scanning
    • Age younger than 50 years

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