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Clinical Intelligence

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

Imran Jawaid and Sharangini Rajesh
British Journal of General Practice 2020; 70 (696): 362-363. DOI: https://doi.org/10.3399/bjgp20X710717
Imran Jawaid
Tunbridge Wells.
Roles: Guideline committee member and portfolio GP
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Sharangini Rajesh
National Guideline Centre, Royal College of Physicians, London.
Roles: Senior research fellow
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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.

PRESENTATION

The signs and symptoms of PHPT are predominantly brought about by hypercalcaemia and include thirst, increased …

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British Journal of General Practice: 70 (696)
British Journal of General Practice
Vol. 70, Issue 696
July 2020
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Hyperparathyroidism (primary) NICE guideline: diagnosis, assessment, and initial management
Imran Jawaid, Sharangini Rajesh
British Journal of General Practice 2020; 70 (696): 362-363. DOI: 10.3399/bjgp20X710717

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Hyperparathyroidism (primary) NICE guideline: diagnosis, assessment, and initial management
Imran Jawaid, Sharangini Rajesh
British Journal of General Practice 2020; 70 (696): 362-363. DOI: 10.3399/bjgp20X710717
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