Specialist Referral for Hyperparathyroidism
Patients with confirmed hyperparathyroidism should be referred to an endocrinologist, and when surgery is indicated, to a surgeon with specific experience in parathyroid disease. 1
Primary Specialist: Endocrinologist
The endocrinologist serves as the primary specialist for managing hyperparathyroidism and should be consulted when:
- Hypercalcemia is confirmed in the context of normal or elevated intact parathyroid hormone (iPTH), which is diagnostic of hyperparathyroidism 1
- Initial biochemical diagnosis requires interpretation and determination of whether the condition is primary, secondary, or tertiary hyperparathyroidism 2, 3
- Medical management is being considered for patients who are not surgical candidates 3, 4
The endocrinologist will coordinate the diagnostic workup, including assessment of vitamin D status, 24-hour urine calcium collection, and evaluation for complications such as kidney stones or bone disease 2, 3.
Surgical Specialist: Experienced Parathyroid Surgeon
Referral to a surgeon with specific expertise in parathyroid disease is essential when surgery is indicated. 1 This is critical because:
- Surgeons who perform high volumes of parathyroid operations have significantly better outcomes 5
- The surgical approach requires specialized knowledge to determine whether minimally invasive parathyroidectomy or bilateral neck exploration is appropriate 1, 3
- Parathyroid surgery carries inherent technical challenges, particularly regarding preservation of normal parathyroid tissue and avoiding complications 1
When to Refer for Surgery
Surgical referral is indicated for:
- All symptomatic patients with primary hyperparathyroidism 3, 5
- Most asymptomatic patients, as parathyroidectomy is more cost-effective than observation and is the only definitive cure 3, 5
- Patients with 24-hour urine calcium >400 mg/day, which indicates increased risk for kidney stones and bone complications 2, 3
- Patients with tertiary hyperparathyroidism showing persistent hypercalcemia despite correction of underlying causes 3
Additional Specialists for Specific Scenarios
For hereditary syndromes (Multiple Endocrine Neoplasia types 1 and 2A, or hyperparathyroid-jaw tumor syndrome), patients should ideally be followed at centers with expertise in genetic interpretation, biochemical analyses, and long-term surveillance 1.
For chronic kidney disease-related secondary hyperparathyroidism, a nephrologist should be involved in management alongside the endocrinologist 3, 4.
Common Pitfalls to Avoid
- Do not delay referral to an endocrinologist once biochemical diagnosis is established, as this can lead to progressive complications 3
- Avoid referring to surgeons without specific parathyroid experience, as surgical outcomes are directly related to surgeon volume and expertise 5
- Do not assume all hyperparathyroidism requires immediate surgery—the endocrinologist must first determine the type (primary, secondary, or tertiary) and assess vitamin D status, as vitamin D deficiency can complicate interpretation 2, 3