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The Eucalcemic Patient With Elevated Parathyroid Hormone Levels

Primary hyperparathyroidism (PHPT) is classically characterized by hypercalcemia with elevated or inappropriately normal parathyroid hormone (PTH) levels. Elevated PTH levels in the presence of normal calcium levels are not infrequently found during the evaluation of metabolic bone disorders or kidn...

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Autores principales: Shaker, Joseph L, Wermers, Robert A
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Oxford University Press 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9922947/
https://www.ncbi.nlm.nih.gov/pubmed/36793479
http://dx.doi.org/10.1210/jendso/bvad013
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author Shaker, Joseph L
Wermers, Robert A
author_facet Shaker, Joseph L
Wermers, Robert A
author_sort Shaker, Joseph L
collection PubMed
description Primary hyperparathyroidism (PHPT) is classically characterized by hypercalcemia with elevated or inappropriately normal parathyroid hormone (PTH) levels. Elevated PTH levels in the presence of normal calcium levels are not infrequently found during the evaluation of metabolic bone disorders or kidney stone disease. This can be caused by secondary hyperparathyroidism (SHPT) or normocalcemic primary hyperparathyroidism (NPHPT). NPHPT is due to autonomous parathyroid function whereas SHPT is caused by a physiologic stimulation to PTH secretion. Many medical conditions and medications can contribute to SHPT, and differentiation between SHPT and NPHPT may be difficult. Cases are presented to illustrate examples. In this paper, we review the distinction between SHPT and NPHPT as well as end organ effects of NPHPT and outcomes of surgery in NPHPT. We suggest that the diagnosis of NPHPT be made only after careful exclusion of causes of SHPT and consideration of medications that can increase PTH secretion. Further, we advise a conservative approach to surgery in NPHPT.
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spelling pubmed-99229472023-02-14 The Eucalcemic Patient With Elevated Parathyroid Hormone Levels Shaker, Joseph L Wermers, Robert A J Endocr Soc Expert Endocrine Consult Primary hyperparathyroidism (PHPT) is classically characterized by hypercalcemia with elevated or inappropriately normal parathyroid hormone (PTH) levels. Elevated PTH levels in the presence of normal calcium levels are not infrequently found during the evaluation of metabolic bone disorders or kidney stone disease. This can be caused by secondary hyperparathyroidism (SHPT) or normocalcemic primary hyperparathyroidism (NPHPT). NPHPT is due to autonomous parathyroid function whereas SHPT is caused by a physiologic stimulation to PTH secretion. Many medical conditions and medications can contribute to SHPT, and differentiation between SHPT and NPHPT may be difficult. Cases are presented to illustrate examples. In this paper, we review the distinction between SHPT and NPHPT as well as end organ effects of NPHPT and outcomes of surgery in NPHPT. We suggest that the diagnosis of NPHPT be made only after careful exclusion of causes of SHPT and consideration of medications that can increase PTH secretion. Further, we advise a conservative approach to surgery in NPHPT. Oxford University Press 2023-01-26 /pmc/articles/PMC9922947/ /pubmed/36793479 http://dx.doi.org/10.1210/jendso/bvad013 Text en © The Author(s) 2023. Published by Oxford University Press on behalf of the Endocrine Society. https://creativecommons.org/licenses/by-nc-nd/4.0/This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs licence (https://creativecommons.org/licenses/by-nc-nd/4.0/), which permits non-commercial reproduction and distribution of the work, in any medium, provided the original work is not altered or transformed in any way, and that the work is properly cited. For commercial re-use, please contact journals.permissions@oup.com
spellingShingle Expert Endocrine Consult
Shaker, Joseph L
Wermers, Robert A
The Eucalcemic Patient With Elevated Parathyroid Hormone Levels
title The Eucalcemic Patient With Elevated Parathyroid Hormone Levels
title_full The Eucalcemic Patient With Elevated Parathyroid Hormone Levels
title_fullStr The Eucalcemic Patient With Elevated Parathyroid Hormone Levels
title_full_unstemmed The Eucalcemic Patient With Elevated Parathyroid Hormone Levels
title_short The Eucalcemic Patient With Elevated Parathyroid Hormone Levels
title_sort eucalcemic patient with elevated parathyroid hormone levels
topic Expert Endocrine Consult
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9922947/
https://www.ncbi.nlm.nih.gov/pubmed/36793479
http://dx.doi.org/10.1210/jendso/bvad013
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