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Monitoring of patients with primary hyperparathyroidism

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

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For all people with primary hyperparathyroidism, assess cardiovascular risk and fracture risk

People who have had successful parathyroid surgery

  • measure calcium (Ca) annually
  • if the person has osteoporosis or renal stones then seek specialist opinion

People who have not had parathyroid surgery, or whose surgery has not been successful

  • measure albumin adjusted serum calcium and eGFR or serum creatinine once a year, unless the person is taking cinacalcet

  • for people taking cinacalcet*, decide whether to continue cinacalcet based on:
    • symptom reduction if initial Ca >=2.85 mmol/litre, or,
    • symptom reduction or Ca level if initial Ca >=3.0 mmol/litre
    • monitor cinacalcet* treatment as set out in the summary of product characteristics

  • consider a DXA scan every 2 to 3 years

  • offer ultrasound of the renal tract if a renal stone is suspected

People who have had parathyroid surgery for multigland disease

  • seek specialist endocrine opinion on monitoring

People who have recurrence after successful surgery

  • seek specialist endocrine opinion on monitoring

Pregnant women with primary hyperparathyroidism

  • consult a specialist centre MDT for advice

*At the time of publication (May 2019) cinacalcet did not have a UK marketing authorisation for use after unsuccessful surgery for primary hyperparathyroidism

Reference:


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