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[Diagnostic tests in parathyroid diseases].

P Burckhardt

    Schweizerische Medizinische Wochenschrift
    |February 8, 1986
    PubMed
    Summary
    This summary is machine-generated.

    Diagnosing primary hyperparathyroidism (PHP) relies on lab tests, especially plasma PTH, to confirm hypercalcemia and rule out malignancy. Differentiating hypoparathyroidism is mainly clinical, with PTH tests offering limited diagnostic value.

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    Area of Science:

    • Endocrinology
    • Clinical Chemistry

    Context:

    • Primary hyperparathyroidism (PHP) diagnosis increasingly relies on laboratory testing, particularly in elderly patients presenting with non-specific symptoms.
    • Hypercalcemia, often subtle, is diagnosed by plasma calcium levels near the upper normal limit.
    • Malignant disease is the most common cause of hypercalcemia, necessitating accurate diagnostic methods.

    Purpose:

    • To outline the diagnostic utility of various laboratory tests in primary hyperparathyroidism (PHP) and hypoparathyroidism.
    • To differentiate PHP from other causes of hypercalcemia.
    • To clarify the role of parathyroid hormone (PTH) and cyclic AMP measurements in diagnosis.

    Summary:

    • Plasma PTH measurement is crucial for diagnosing hypercalcemia and excluding malignancy in suspected PHP.

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  • Blood phosphorus, chloride, alkaline phosphatase, and urinary calcium/phosphorus aid in assessing metabolic effects but not causal diagnosis.
  • Urinary and nephrogenous cyclic AMP levels reflect PTH secretion but can be elevated in paraneoplastic hypercalcemia; dynamic tests for subtle PHP are mainly of scientific interest.
  • Hypoparathyroidism diagnosis is primarily clinical; PTH levels are often unhelpful. In hypocalcemia, elevated PTH (except in hypomagnesemia) suggests non-parathyroid origin. Urinary cyclic AMP or stimulated PTH levels aid in borderline cases.

    • Impact:

    • Provides a clear guide for clinicians on selecting appropriate laboratory tests for diagnosing hyperparathyroidism and hypoparathyroidism.
    • Highlights the limitations of certain tests, preventing misdiagnosis and unnecessary investigations.
    • Emphasizes the importance of plasma PTH in differentiating hypercalcemia causes, improving patient management strategies.