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Hypercalcaemia - Management
What monitoring is required for a person with asymptomatic, confirmed primary hyperparathyroidism who has not undergone parathyroidectomy?
- Following specialist endocrine assessment, monitoring of people with asymptomatic primary hyperparathyroidism who have no indications for parathyroidectomy or who decline parathyroidectomy may be done in primary care, if this is agreed locally.
- Monitor:
- Serum calcium and renal function — every 12 months.
- Blood pressure — every 6 months; manage as for essential hypertension. See the CKS topic on Hypertension - not diabetic.
- Bone mineral density (at the lumbar spine, femoral neck, total hip, and distal radius) — every 1–2 years, depending on local guidance.
- For symptoms of hypercalcaemia — opportunistically.
- Refer the person back to the endocrinologist if:
- Symptoms of hypercalcaemia develop.
- Adjusted serum calcium concentration increases to 0.25 mmol/L or more above the upper end of the normal range (for example greater than 2.90 mmol/L).
- Estimated glomerular filtration rate is less than 60 mL/min.
- At any site on bone mineral density measurement, the T-score is –2.5 or less (for peri-menopausal or postmenopausal women, and men 50 years of age or older) or the Z-score is –2.5 or less (for premenopausal women and men younger than 50 years of age).
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