Diagnosis of primary hyperparathyroidism in adults

The most common clinical presentation of primary hyperparathyroidism is asymptomatic hypercalcemia. The diagnosis is usually first suspected because of the incidental finding of an elevated serum calcium concentration on biochemical screening tests. In addition, primary hyperparathyroidism may be suspected in a patient with nephrolithiasis.

PTH: parathyroid hormone; FHH: familial hypocalciuric hypercalcemia.

* A PTH within the mid-upper normal range is inappropriately normal given hypercalcemia.

¶ If the patient is taking a thiazide diuretic or lithium, discontinue (if the drug can be stopped without exacerbating the underlying condition) and remeasure calcium and PTH in 3 months. Persistent hypercalcemia with elevated or high-normal PTH after drug withdrawal suggests that the drug has unmasked primary hyperparathyroidism.

Δ Refer to UpToDate content on distinguishing between primary hyperparathyroidism and FHH.

◊ Examples of non-PTH mediated hypercalcemia include humoral hypercalcemia of malignancy, vitamin D intoxication, granulomatous disease, vitamin A intoxication, and hyperthyroidism.

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Diagnosis of primary hyperparathyroidism in adults