Hyperparathyroidism (primary) NICE guideline: diagnosis, assessment, and initial management

INTRODUCTION

Parathyroid hormone (PTH) is secreted from four parathyroid glands situated behind the thyroid gland. PTH regulates calcium and phosphate levels by its promotion of phosphate excretion and calcium reabsorption in the kidneys; stimulation of osteoclastic activity in the bone resulting in raised serum calcium; and increased intestinal absorption of calcium. Hyperparathyroidism is excessive secretion of PTH and can be primary, secondary, or tertiary:

• primary hyperparathyroidism occurs when ≥1 parathyroid glands produce too much PTH (the most common cause is an adenoma);

• secondary occurs when the increased PTH secretion is due to an organic cause (such as kidney, liver, or bowel disease causing hypocalcaemia and a subsequent increase in PTH secretion); and,

• tertiary is a consequence of persistent parathyroid stimulation (such as long-standing secondary hyperparathyroidism), which results in autonomous (unregulated) PTH function.¹

This article summarises the new National Institute for Health and Care Excellence (NICE) guideline for the diagnosis, assessment, and initial management of primary hyperparathyroidism (PHPT).² This article highlights areas of particular importance for primary care. The causes and management of hypercalcaemia outside of the diagnosis and management of PHPT are beyond the scope of this article.