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Diagnosis of Asymptomatic Primary Hyperparathyroidism: Proceedings of the Third International Workshop

University of Sheffield (R.E.), Sheffield S10 2TN, United Kingdom; Center for Molecular Medicine and Division of Endocrinology and Metabolism (A.A.), University of Connecticut School of Medicine, Farmington, Connecticut 06030; Department of Internal Medicine (M.L.B.), University of Florence, 50133 Florence, Italy; Division of Endocrinology (E.R.B.), Diabetes and Hypertension, Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts 02115; Research Center (P.D.), Centre Hospitalier de l’Université de Montréal, Hôpital Saint-Luc and Department of Medicine, University of Montréal, Montréal, Québec, Canada H3C 3J7; Departments of Medicine, Community Health Sciences, and Oncology (D.A.H.), Division of Endocrinology and Metabolism, University of Calgary, Calgary, Alberta, Canada AB T2N 1N4; Bone and Mineral Research Laboratory (D.S.R.), Henry Ford Hospital, Detroit, Michigan 48202; Division of Endocrinology (M.J.R., S.J.S.), Columbia University College of Physicians and Surgeons, New York, New York 10032; Department of Medicine (D.G.), McGill University and McGill University Health Centre, Montreal, Quebec, Canada QC H3G 1A4; Metabolic Diseases Branch (S.M.), National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland 20892; Indiana University Medical School (M.P.), Indianapolis, Indiana 46202; Department of Endocrinology (L.M.), Aarhus University Hospital, Aarhus Sygehus, Tage-Hansens Gade 2, DK-8000 Aarhus, Denmark; Katholieke Universiteit Leuven (R.B.), Laboratory of Experimental Medicine and Endocrinology, 3000 Leuven, Belgium; and New Mexico Clinical Research and Osteoporosis Center (E.M.L.), University of New Mexico School of Medicine, Albuquerque, New Mexico 87106

Address all correspondence and requests for reprints to: Richard Eastell, M.D., FRCP, FRCPath, FMedSci, Professor of Bone Metabolism, Head of the Academic Unit of Bone Metabolism, Metabolic Bone Centre, Sorby Wing, Northern General Hospital, Herries Road, Sheffield, South Yorkshire S5 7AU, United Kingdom. E-mail: r.eastell{at}sheffield.ac.uk.

Objective: Asymptomatic primary hyperparathyroidism (PHPT) is a common clinical problem. The purpose of this report is to guide the use of diagnostic tests for this condition in clinical practice.

Participants: Interested professional societies selected a representative for the consensus committee and provided funding for a one-day meeting. A subgroup of this committee set the program and developed key questions for review. Consensus was established at a closed meeting that followed. The conclusions were then circulated to the participating professional societies.

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) DNA sequence testing can be useful in familial hyperparathyroidism or hypercalcemia; 4) normocalcemic PHPT is a variant of the more common presentation of PHPT with hypercalcemia; 5) serum 25-hydroxyvitamin D levels should be measured and, if vitamin D insufficiency is present, it should be treated as part of any management course; and 6) the estimated glomerular filtration rate should be used to determine the level of kidney function in PHPT: an estimated glomerular filtration rate of less than 60 ml/min · 1.73 m² should be a benchmark for decisions about surgery in established asymptomatic PHPT.

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				J. P. Bilezikian, A. A. Khan, J. T. Potts Jr, and on behalf of the Third International Workshop on t Guidelines for the Management of Asymptomatic Primary Hyperparathyroidism: Summary Statement from the Third International Workshop J. Clin. Endocrinol. Metab., February 1, 2009; 94(2): 335 - 339. [Abstract] [Full Text] [PDF]