Parathyroid disease
Primary hyperparathyroidism under the Australian and New Zealand position statements (online 2021, Clin Endocrinol 2024) and the 2022 Fifth International Workshop (who to operate on, how to localise, what cure looks like), plus FHH, lithium, parathyroid carcinoma, secondary and tertiary hyperparathyroidism and hypoparathyroidism.
Tier 2Condition
Written with AI assistance and fact-checked against the sources below. For exam study, not clinical decisions. How notes are made
At a glance
- Primary hyperparathyroidism (PHPT) is the commonest cause of hypercalcaemia in outpatients. Most are postmenopausal women with mild, asymptomatic disease found on routine bloods.
- Diagnosis is biochemical: high calcium with a raised or inappropriately normal PTH, after excluding FHH, lithium and thiazides. Imaging comes later and only for surgical planning.
- Parathyroidectomy is the only cure. The Australian and New Zealand (ESA, ANZES, ANZBMS) position statement (online 2021; Clin Endocrinol 2024) advises it for all symptomatic patients and suggests considering it in any asymptomatic patient fit for surgery with a life expectancy over 10 years.
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Sources
- Primary hyperparathyroidism in adults (Part I): assessment and medical management. Position statement of the Endocrine Society of Australia, the Australian & New Zealand Endocrine Surgeons, and the Australian & New Zealand Bone and Mineral SocietyAU/NZClinical Endocrinology (Milat F, Ramchand SK, Herath M, et al.; 100:3-18), 2024
- Primary hyperparathyroidism in adults (Part II): surgical management and postoperative follow-up. Position statement of the Endocrine Society of Australia, the Australian & New Zealand Endocrine Surgeons, and the Australian & New Zealand Bone and Mineral SocietyAU/NZClinical Endocrinology (Miller JA, Gundara J, Harper S, et al.; 101:516-30), 2024
- Evaluation and management of primary hyperparathyroidism: summary statement and guidelines from the Fifth International WorkshopJournal of Bone and Mineral Research (Bilezikian JP, et al.; 37:2293-314), 2022
- Best practice recommendations for the diagnosis and management of hypoparathyroidismMetabolism (Khan AA, et al.; 171:156335), 2025
- KDIGO 2017 clinical practice guideline update for the diagnosis, evaluation, prevention, and treatment of chronic kidney disease-mineral and bone disorder (CKD-MBD)Kidney International Supplements (KDIGO), 2017
- Shahraki RA, Meehan AD, Wallin G, Daskalakis K. Lithium-associated hyperparathyroidism: a systematic review of prevalence and surgical outcomes. Langenbecks Arch Surg 2026;411:216Langenbeck's Archives of Surgery, 2026
- Palopegteriparatide (Yorvipath) PBS medicine statusAU/NZPharmaceutical Benefits Scheme, July 2025 PBAC outcome
- Last updated
- 14 November 2026
What changed
- 14 November 2026 Personal emails, About story and Australian-style copy