Guidelines

Hyperparathyroidism

• 2005: American HPTH guidelines (NIH, NIDDK 2002): http://www.aace.com/pub/pdf/guidelines/HyperparathyroidPS.pdf
• Suggested indications for surgery:
• age<50
• unable to participate in FU
• Ca>1mg/dL(>0.25mM/L) above ULN
• U-Ca>400mg/d(=10mM/d)
• >=30% dcr in renal function
• complications
• nephrocalcinosis
• osteoporosis (T< -2.5 @LS/hjp/wrist)
• severe neuropsychologic disorder
• Medical therapy:
• keep well hydrated (+-Furosemide if well hydrated)
• Anti-bone-resorption therapy: bisphosphonates, estrogens [NB: little effect on Ca levels]
• calcimimetics (Cinacalcit)
• 1999: British Association of Endocrine and Thyroid Surgeons:
• 1999 Guidelines: http://www.baes.info/Pages/BAETS%20Guidelines.pdf;
• 2007: NICE on Cinacalcet in 2ry HPTH in CKD: www.nice.org.uk/guidance/TA117/guidance/pdf/English
• 2004: Alendronate in PHPT: http://www.ncbi.nlm.nih.gov/pubmed/15240609 [JCEM | pdf]