Diagnosis of asymptomatic primary hyperparathyroidism: proceedings of the third international workshop.

Abstract

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.

• Authors: R Eastell, A Arnold, M L Brandi, E M Brown, P D'Amour, D A Hanley, D Sudhaker Rao, M R Rubin, D Goltzman, S J Silverberg, S J Marx, M Peacock, L Mosekilde, R Bouillon, E M Lewiecki
• Journal: The Journal of clinical endocrinology and metabolism (J Clin Endocrinol Metab) Vol. 94 Issue 2 Pg. 340-50 (Feb 2009) ISSN: 0021-972X [Print] United States
• PMID: 19193909 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't, Review)

Chemical References

• CASR protein, human
• MEN1 protein, human
• Parathyroid Hormone
• Proto-Oncogene Proteins
• Receptors, Calcium-Sensing
• Vitamin D

Topics

• Avitaminosis (blood, complications, diagnosis)
• Consensus
• DNA Mutational Analysis (methods)
• Diagnostic Techniques, Endocrine (standards)
• Humans
• Hyperparathyroidism, Primary (complications, diagnosis, genetics)
• Parathyroid Hormone (blood)
• Proto-Oncogene Proteins (genetics)
• Receptors, Calcium-Sensing (genetics)
• Vitamin D (blood)