From the Guidelines
Hyperparathyroidism Diagnosis and Management The patient's lab results indicate elevated parathyroid hormone (PTH) levels, which may suggest primary hyperparathyroidism, as evidenced by the high PTH level of 12.1, above the upper limit of 10.8, and slightly elevated calcium level of 2.23, with a low phosphate level of 0.77, and a normal 25-OH Vitamin D level of 90 1.
Key Findings
- Elevated PTH levels: 12.1 (above upper limit of 10.8)
- Slightly elevated calcium level: 2.23
- Low phosphate level: 0.77
- Normal 25-OH Vitamin D level: 90
Management Recommendations
As a precautionary measure, it is recommended to:
- Monitor the patient's calcium and PTH levels closely and consider a repeat measurement to confirm the results 1
- Advise the patient to maintain adequate hydration and avoid excessive calcium and vitamin D intake In terms of medication, the patient may require treatment with:
- A bisphosphonate, such as alendronate 70mg weekly, to help manage hyperparathyroidism and prevent complications
- A calcimimetic agent, such as cinacalcet 30mg daily, to help manage hyperparathyroidism and prevent complications 1 However, the specific treatment plan should be determined by an endocrinologist based on the patient's individual needs and medical history.
Additional Considerations
- The patient's phosphate level is low, which may indicate a need for phosphate supplements, but this should be done with caution to avoid promoting secondary hyperparathyroidism 1
- The patient's 25-OH Vitamin D level is within normal range, but vitamin D deficiency is a common cause of secondary hyperparathyroidism, and supplementation may be necessary if deficiency is present 1
From the Research
Interpretation of Hyperparathyroidism
The interpretation of hyperparathyroidism is based on the levels of Calcium, Phosphate, Alkaline Phosphatase, and 25-Hydroxyvitamin D.
- Hyperparathyroidism is characterized by hypercalcemia and elevated or inappropriately normal serum levels of parathyroid hormone (PTH) 2.
- Primary hyperparathyroidism (PHPT) is the most common cause of hypercalcemia in the outpatient setting, and symptomatic presentation includes non-specific signs and symptoms of hypercalcemia, skeletal fragility, nephrolithiasis, and nephrocalcinosis 3.
- The diagnosis of primary hyperparathyroidism is straightforward when the traditional hypercalcemic patient is documented to have an elevated parathyroid hormone (PTH) level 4.
Laboratory Findings
- Elevated PTH levels and hypercalcemia are commonly seen in patients with primary hyperparathyroidism 5, 6.
- Serum biochemistries may reveal high serum calcium, serum PTH, and serum creatinine levels, as well as low bone mineral density 6.
- Laboratory findings may also show elevated alkaline phosphatase levels, which can indicate bone involvement 4.
Medical Management
- Medical management may be considered in patients with mild asymptomatic disease, contraindications to surgery, or failed previous surgical intervention 3.
- Calcium and vitamin D intake should be optimized, and antiresorptive therapy may be used for skeletal protection in patients with an increased fracture risk 3.
- Cinacalcet, a calcimimetic agent, has been shown to effectively lower serum calcium and PTH levels 3.
Surgical Treatment
- Parathyroidectomy is the only curative treatment for primary hyperparathyroidism and is recommended in patients with symptoms and those with asymptomatic disease who are at risk of progression or have subclinical evidence of end-organ sequelae 2.
- Parathyroidectomy results in an increase in bone mineral density (BMD) and a reduction in nephrolithiasis 2.
- Surgical treatment should be performed by an experienced surgeon, and intraoperative intact PTH monitoring and frozen section diagnosis may be useful in ensuring curative treatment 5.