Hypercalcaemia and primary hyperparathyroidism

Abstract

Hypercalcaemia is most commonly caused by primary hyperparathyroidism (PHPT) or malignancy. PHPT is common, affects women more than men, and is usually caused by a solitary parathyroid adenoma. The most common presentation is an asymptomatic incidental finding on blood tests performed for another indication. The only curative treatment is parathyroidectomy. In 2019, National Institute for Health and Care Excellence guidelines were published regarding the management of PHPT. These recommended a surgical referral for confirmed PHPT, particularly if patients display symptoms of hypercalcaemia or show end-organ disease, or if albumin-adjusted calcium concentrations are >2.85 mmol/litre. In patients who have had unsuccessful surgery, multidisciplinary team discussions are recommended to consider reoperation. Clear guidelines on the usage of calcimimetics and bisphosphonates, as well as the routine monitoring of patients in this group, have been given. Other emerging aspects of the field that are discussed in this article include the role of genetic testing in PHPT and the diagnosis and management of normocalcaemic PHPT.