Diagnosis of asymptomatic primary hyperparathyroidism: proceedings of the third international workshop.
OBJECTIVE
Asymptomatic primary hyperparathyroidism (PHPT) is a common clinical problem. The purpose of this report is to guide the use of diagnostic tests for this condition in clinical practice.


METHODS
Interested professional societies selected a representative for the consensus committee and provided funding for a one-day meeting. A subgroup of this committee set the program and developed key questions for review. Consensus was established at a closed meeting that followed. The conclusions were then circulated to the participating professional societies.


METHODS
Each question was addressed by a relevant literature search (on PubMed), and the data were presented for discussion at the group meeting.


METHODS
Consensus was achieved by a group meeting. Statements were prepared by all authors, with comments relating to accuracy from the diagnosis subgroup and by representatives from the participating professional societies.


CONCLUSIONS
We conclude that: 1) reference ranges should be established for serum PTH in vitamin D-replete healthy individuals; 2) second- and third-generation PTH assays are both helpful in the diagnosis of PHPT; 3) DNA sequence testing can be useful in familial hyperparathyroidism or hypercalcemia; 4) normocalcemic PHPT is a variant of the more common presentation of PHPT with hypercalcemia; 5) serum 25-hydroxyvitamin D levels should be measured and, if vitamin D insufficiency is present, it should be treated as part of any management course; and 6) the estimated glomerular filtration rate should be used to determine the level of kidney function in PHPT: an estimated glomerular filtration rate of less than 60 ml/min.1.73 m2 should be a benchmark for decisions about surgery in established asymptomatic PHPT.
Eastell
R
R
University of Sheffield, Sheffield, United Kingdom. r.eastell@sheffield.ac.uk
Arnold
A
A
Brandi
M L
ML
Brown
E M
EM
D'Amour
P
P
Hanley
D A
DA
Rao
D Sudhaker
DS
Rubin
M R
MR
Goltzman
D
D
Silverberg
S J
SJ
Marx
S J
SJ
Peacock
M
M
Mosekilde
L
L
Bouillon
R
R
Lewiecki
E M
EM
D001361:Avitaminosis / Q000097:blood / Q000150:complications / Q000175:diagnosis; D032921:Consensus; D004252:DNA Mutational Analysis / Q000379:methods; D003940:Diagnostic Techniques, Endocrine / Q000592:standards; D006801:Humans; D049950:Hyperparathyroidism, Primary / Q000150:complications / Q000175:diagnosis* / Q000235:genetics; D010281:Parathyroid Hormone / Q000097:blood; D011518:Proto-Oncogene Proteins / Q000235:genetics; D044169:Receptors, Calcium-Sensing / Q000235:genetics; D014807:Vitamin D / Q000097:blood
C095550:CASR protein, human; C105373:MEN1 protein, human; D010281:Parathyroid Hormone; D011518:Proto-Oncogene Proteins; D044169:Receptors, Calcium-Sensing; D014807:Vitamin D