Monitoring of patients with primary hyperparathyroidism

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

• prescriber should follow relevant professional guidance, taking full responsibility for the decision
• informed consent should be obtained and documented. See the General Medical Council's Prescribing guidance: prescribing unlicensed medicines for further information.

Reference:

• NICE (May 2019). Primary Hyperparathyroidism.