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Diagnosis of asymptomatic primary hyperparathyroidism: proceedings of the Fourth International Workshop
Richard Eastell1, Maria Luisa Brandi, Aline G Costa
1Academic Unit of Bone Metabolism (R.E.), University of Sheffield, Sheffield S5 7AU, United Kingdom; University of Florence (M.L.B.), 50133 Florence, Italy; Department of Medicine (A.G.C.), Division of Endocrinology, Metabolic Bone Diseases Unit, College of Physicians and Surgeons, Columbia University, New York, New York 10032; Department of Medicine (A.G.C.), Division of Endocrinology, São Paulo Federal University, São Paulo 04021-001, Brazil; Centre Hospitalier de l'Université de Montréal (P.D.), Hôpital St-Luc and Department of Medicine, University of Montréal, Montréal, Québec, Canada H3C 3J7; Endocrine Research Unit (D.M.S.), San Francisco Department of Veterans Affairs Medical Center, University of California, San Francisco, California 94121; and Academic Endocrine Unit (R.V.T.), Radcliffe Department of Medicine, University of Oxford, Oxford OX3 7LJ, United Kingdom.
Objective:
Asymptomatic primary hyperparathyroidism (PHPT) is a common clinical problem. The purpose of this report is to provide an update on the use of diagnostic tests for this condition in clinical practice.
Participants:
This subgroup was constituted by the Steering Committee to address key questions related to the diagnosis of PHPT. Consensus was established at a closed meeting of the Expert Panel that followed.
Evidence:
Each question was addressed by a relevant literature search (on PubMed), and the data were presented for discussion at the group meeting.
Consensus Process:
Consensus was achieved by a group meeting. Statements were prepared by all authors, with comments relating to accuracy from the diagnosis subgroup and by representatives from the participating professional societies.
Conclusions:
We conclude that: 1) reference ranges should be established for serum PTH in vitamin D-replete healthy individuals; 2) second- and third-generation PTH assays are both helpful in the diagnosis of PHPT; 3) normocalcemic PHPT is a variant of the more common presentation of PHPT with hypercalcemia; 4) serum 25-hydroxyvitamin D concentrations should be measured and, if vitamin D insufficiency is present, it should be treated as part of any management course; 5) genetic testing has the potential to be useful in the differential diagnosis of familial hyperparathyroidism or hypercalcemia.
