According to guidelines, when is surgery indicated for primary hyperparathyroidism?

Updated: Oct 02, 2018
  • Author: Lawrence Kim, MD, FACS, FACE; Chief Editor: Romesh Khardori, MD, PhD, FACP  more...
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Answer

Answer

Guidelines for the management of asymptomatic primary hyperparathyroidism were updated in 2013 by the Fourth International Workshop on Asymptomatic Primary Hyperparathyroidism. Indications for surgery include the following [17] :

  • Serum calcium >1 mg/dL above the upper limit of the reference range

  • Bone mineral density T-score at or below -2.5 (in perimenopausal or postmenopausal women and in men aged 50 years or older) at the lumbar spine, total hip, femoral neck, or distal 1/3 radius

  • Vertebral fracture as evidenced via radiography or vertebral fracture assessment (VFA)

  • Creatinine clearance of < 60 cc/min

  • Twenty-four–hour urinary calcium excretion >400 mg/day and increased stone risk as assessed through biochemical stone risk analysis.

  • Presence of nephrolithiasis or nephrocalcinosis as determined using radiography, ultrasonography, or CT scanning

  • Age younger than 50 years


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