Guidelines for surgery in asymptomatic PHPT*

Measurement	Indication(s) for surgery
Serum calcium	>1 mg/dL (0.25 mmol/L) above the upper limit of normal
Skeletal	BMD by DXA: T-score ≤–2.5 at lumbar spine, total hip, femoral neck, or distal 1/3 radius^¶ Vertebral fracture by radiograph, CT, MRI, or VFA
Kidney	eGFR <60 mL/min/1.73 m² 24-hour urine for calcium >250 mg/day (6.25 mmol/day) in women and >300 mg/day (7.5 mmol/day) in men Presence of nephrolithiasis or nephrocalcinosis by radiograph, ultrasound, or CT
Age	<50 years

Patients need to meet only 1 of these criteria to be advised to have parathyroid surgery. They do not have to meet more than 1.

PHPT: primary hyperparathyroidism; BMD: bone mineral density; DXA: dual-energy x-ray absorptiometry; CT: computed tomography; MRI: magnetic resonance imaging; VFA: vertebral fracture assessment; eGFR: estimated glomerular filtration rate; ISCD: International Society for Clinical Densitometry.

* Surgery is also indicated in patients for whom medical surveillance is neither desired nor possible and in patients opting for surgery, in the absence of meeting any indications, as long as there are no medical contraindications.

¶ Consistent with the position established by the ISCD, the use of Z-scores instead of T-scores is recommended in evaluating BMD in premenopausal women and men younger than 50 years.^[1]

Reference:

Shuhart CR, Yeap SS, Anderson PA, et al. Executive Summary of the 2019 ISCD Position Development Conference on Monitoring Treatment, DXA Cross-Calibration and Least Significant Change, Spinal Cord Injury, Peri-Prosthetic and Orthopedic Bone Health, Transgender Medicine, and Pediatrics. J Clin Densitom 2019; 22:453.

Modified with permission from from: Bilezikian JP, Khan AA, Silverberg SJ, et al. Evaluation and Management of Primary Hyperparathyroidism: Summary Statement and Guidelines from the Fifth International Workshop. J Bone Miner Res 2022; 37:2293. https://asbmr.onlinelibrary.wiley.com/doi/10.1002/jbmr.4677. Copyright © 2022 American Society for Bone and Mineral Research. This image has been provided by or is owned by Wiley. Further permission is needed before it can be downloaded to PowerPoint, printed, shared or emailed. Please contact Wiley's permissions department either via email: [email protected] or use the RightsLink service by clicking on the 'Request Permission' link accompanying this article on Wiley Online Library (https://onlinelibrary.wiley.com/).

Graphic 63054 Version 13.0

خرید پکیج

Guidelines for surgery in asymptomatic PHPT*