From the Research
Management of primary hyperparathyroidism in primary care according to NICE guidelines in the UK involves a structured approach based on the severity and type of the condition, with recent evidence from 2023 suggesting the efficacy of antiresorptive agents like bisphosphonates and denosumab in mitigating hypercalcemia and bone loss 1. For primary hyperparathyroidism, initial management includes:
- Monitoring serum calcium and parathyroid hormone (PTH) levels every 6-12 months in asymptomatic patients with mild hypercalcaemia (calcium <2.85 mmol/L)
- Maintaining adequate hydration and avoiding thiazide diuretics which can worsen hypercalcaemia
- Considering bisphosphonates for those with osteoporosis, as they have been shown to increase bone mineral density and decrease serum calcium levels 1 Referral to an endocrinologist is necessary for:
- Symptomatic patients
- Those with calcium >2.85 mmol/L
- Evidence of end-organ damage (renal stones, osteoporosis)
- Age <50 years
- Declining renal function It is essential to note that parathyroidectomy is the only curative treatment for primary hyperparathyroidism, and it 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. Regular monitoring of calcium, phosphate, PTH, and vitamin D levels is essential, with frequency determined by disease severity. Patient education about dietary calcium intake, hydration, and symptoms of hypercalcaemia is crucial for effective management. The use of antiresorptive agents like bisphosphonates and denosumab has been shown to be effective in mitigating bone loss and hypercalcemia in primary hyperparathyroidism, while maintaining or increasing bone mineral density 1. In patients who do not meet guidelines for surgery, a nonsurgical management approach has merit, with a focus on monitoring symptoms, serum calcium and creatinine levels, and bone mineral density 3.