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Hypercalcaemia - Management
How is primary hyperparathyroidism managed in secondary care?

  • In secondary care, the endocrinologist may:
    • Confirm the diagnosis, by:
      • Excluding other causes of hypercalcaemia.
      • Measuring the 25-hydroxyvitamin D level, as this affects the interpretation of parathyroid hormone levels.
      • Measuring 24-hour urinary calcium. Low levels indicate familial hypocalciuric hypercalcaemia.
    • Assess the need for parathyroidectomy and referral to a parathyroid surgeon. Indications for parathyroidectomy include:
      • Symptomatic disease.
      • People younger than 50 years of age.
      • Kidney stones.
      • Adjusted serum calcium concentration that is 0.25 mmol/L or more above the upper end of the reference range.
      • Estimated glomerular filtration rate less than 60 mL/min (although this threshold depends on other factors, such as age).
      • Reduced bone mineral density at the lumbar spine, femoral neck, total hip, or distal radius (T-score –2.5 or less for peri-menopausal or postmenopausal women, and men 50 years of age or older; Z-score –2.5 or less for premenopausal women and men younger than 50 years of age).
    • Manage people who do not undergo parathyroidectomy. This includes:
      • Monitoring.
      • Vitamin D supplements, if necessary.
      • Advice on a normal dietary intake of calcium.
      • If appropriate, treatment with a bisphosphonate. Other options for treatment (if required) include hormone replacement therapy, raloxifene, and the calcimimetic drug cinacalcet.

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