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Uptodate Reference Title
Guidelines for surgery in asymptomatic PHPT*
Guidelines for surgery in asymptomatic PHPT*
Measurement
2014
Serum calcium (>upper limit of normal)
1.0 mg/dL (0.25 mmol/L)
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
Renal
Creatinine clearance <60 mL/min
24-hour urine for calcium >400 mg/day (>10 mmol/day) and increased stone risk by biochemical stone risk analysisΔ
Presence of nephrolithiasis or nephrocalcinosis by radiograph, ultrasound, or CT
Age (years)
<50
Patients need to meet only one of these criteria to be advised to have parathyroid surgery. They do not have to meet more than one.
PHPT: primary hyperparathyroidism; BMD: bone mineral density; DXA: dual-energy x-ray absorptiometry; CT: computed tomography; MRI: magnetic resonance imaging; VFA: vertebral fracture assessment; 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 guidelines, 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. Δ Most clinicians will first obtain a 24-hour urine for calcium excretion. If marked hypercalciuria is present (>400 mg/day [>10 mmol/day]), further evidence of calcium-containing stone risk should be sought by a urinary biochemical stone risk profile, available through most commercial laboratories. In the presence of abnormal findings indicating increased calcium-containing stone risk and marked hypercalciuria, a guideline for surgery is met.
