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December 2010 Endocrine Newsletter >>
Evaluation of Hyperparathyroidism
The most common cause of hypercalcemia in the outpatient setting is primary hyperparathyroidism. Primary hyperparathyroidism is often discovered as an elevated calcium level on a routine blood draw. Traditional symptoms are kidney stones, occurring in 10-15% of patients, and fractures. While fractures are less common, osteopenia and osteoporosis are very common.
A majority of patients do not present with kidney stones or bone disease – they are labeled “asymptomatic” hyperparathyroidism. However, when questioned, over 80% of these “asymptomatic” patients actually do have significant symptoms related to their hyperparathyroidism.
The most common symptoms are:
Other symptoms of hyperparathyroidism include:
What do you do when a patient presents with an elevated calcium level on routine labs?
Options: Treatment vs. Observation
Reasons to consider parathyroidectomy:
Minimally invasive parathyroidectomy:
There are numerous benefits to surgical treatment of primary hyperparathyroidism. Because of these benefits, the American Association of Clinical Endocrinologist (AACE) and the American Association of Endocrine Surgeons (AAES) have recommended that “operative management should be considered and recommended for all asymptomatic patients with primary hyperparathyroidism who have a reasonable life expectancy and suitable operative risk factors. Consultation with an experienced endocrinologist and surgeon can help clarify the patient’s risk/benefit ratio.”
For more information on the surgical treatment of primary hyperparathyroidism, please click here.