Hyperparathyroidism (primary): diagnosis, assessment and initial management

Context

Primary hyperparathyroidism is a disorder of one or more of the parathyroid glands. The parathyroid gland becomes overactive and secretes excess amounts of parathyroid hormone, causing hypercalcaemia, hypophosphataemia and hypercalciuria. The most common cause of primary hyperparathyroidism is a non-cancerous tumour (an adenoma) in one of the parathyroid glands.

Primary hyperparathyroidism is one of the leading causes of hypercalcaemia and one of the most common endocrine disorders. About 1 to 4 people per 1,000 are known to have the condition. Women are twice as likely to develop primary hyperparathyroidism as men. It can develop at any age, but in women in the UK, it is most often diagnosed between the ages of 50 and 60.

The signs and symptoms of primary hyperparathyroidism are predominantly brought about by hypercalcaemia and include thirst and increased urine output, gastrointestinal symptoms such as constipation, and effects on the central nervous system such as fatigue and memory impairment. Long-term effects include kidney stones, bone-related complications such as osteoporosis and fractures, and cardiovascular disease.

This guideline provides recommendations on recognition, diagnosis and management of primary hyperparathyroidism. It offers advice for primary care professionals on initial diagnostic testing. It also provides guidance for secondary care professionals on indications for surgery, preoperative imaging, types of surgery and follow‑up care after surgery.