| People who have had successful parathyroid surgery | People who have not had parathyroid surgery, or whose surgery has not been successful |
|---|---|
| Measure albumin-adjusted serum calcium once a year. |
Measure albumin-adjusted serum calcium and eGFR or serum creatinine once a year, unless the person is taking cinacalcet*. If the person is taking cinacalcet, offer monitoring as set out in the summary of product characteristics. If the results of monitoring raise concerns, follow recommendation 1.1.4. |
| If the person has osteoporosis, seek specialist opinion according to local pathways on monitoring. | Consider a DXA scan at diagnosis and every 2 to 3 years. If the results of monitoring raise concerns, follow recommendation 1.3.1. |
| If the person has renal stones, seek specialist opinion according to local pathways on monitoring. |
Offer ultrasound of the renal tract at diagnosis, when presenting and if a renal stone is suspected (for recommendations on assessing and managing renal stones, see the NICE guideline on renal and ureteric stones). If the results of monitoring raise concerns, follow recommendation 1.3.1. |
| For people who have had parathyroid surgery for multigland disease, or have disease that recurs after successful surgery, seek specialist endocrine opinion on monitoring. | |
| For women who are pregnant, see the section on pregnancy in this guideline. | |
| For all people with primary hyperparathyroidism, assess cardiovascular risk and fracture risk in line with the NICE guidelines on cardiovascular disease and osteoporosis. | |
DXA, dual-energy X-ray absorptiometry; EGFR, estimated glomerular filtration rate.
At the time of publication (May 2019), cinacalcet did not have a UK marketing authorisation for use after unsuccessful surgery for primary hyperparathyroidism. The 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.
From: Hyperparathyroidism (primary): diagnosis, assessment and initial management
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