Avoid lithium or hydrochlorothiazide therapy, immobilization and intravascular volume depletion (Pallan, Khan, 2011).
Surgical Management (parathyroidectomy)
The most recent guidelines for surgery were revised in 2009:
Serum Ca > 1.0 mg/dl
reduction in CrCl <60 mL/min
T-score < 2.5 at any site on bone mineral density and/or previous fracture fragility
<50 years of age
24 hr calcium excretion >400 mg (optional, not definitive due to other causes for stones, but some providers still use this as part of the criteria) (Pyram et al., 2011)
Hyperparathyroidism
Treatment
Medical Management
- 25% of patients can manage medically for 10 years then need surgery (Turner, 2009).
- For those who do not elect surgery or are not candidates for surgery follow this criteria for follow-up.
- Annual serum calcium
- Annual serum creatinine
- Bone density every 1-2 years at 3 sites
- Pharmacological Treatment
- Biphosphonates: IV pamidronate and oral alendronate have been shown to improve disease within 1st month of treatment
- Should not be given to candidates who will have surgery, but optimal for patients that are not.
- Cinacalcet - (approved by FDA 2011)
- this calcimimetic lowers PTH levels by sensitizing PTH to extracellular Ca, therefore decreasing PTH and Ca reabsorption
- Reduces PTH levels and stabilzes Ca levels, without affecting bone mineral density
- Hormone replacement therapy improved bone mineral density for postmenopausal women (Pallan, Khan, 2011).
- Non-pharmacological
- Vitamin D replacement
- 400 - 800 IU/day
- This is used pre-surgery if levels are less than 20 ng/mL (Pyram et al., 2011).
- There needs to be more research on this due to Vitamin D causing hypercalciuria
- Dietary Calcium (for moderately elevated patients)
- 1000 - 1200 mg/day
- Engage in physical activity and hydration
- Avoid lithium or hydrochlorothiazide therapy, immobilization and intravascular volume depletion (Pallan, Khan, 2011).
Surgical Management (parathyroidectomy)