The Curbsiders Internal Medicine Podcast #443 Primary Hyperparathyroidism: Stones, bones, and almost certainly some groans
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Jun 10, 2024 
Dr. Lindsay Kuo from Temple University Hospital discusses primary hyperparathyroidism. Topics include surgery criteria, vitamin D's role, PTH testing, parathyroid imaging, and post-op monitoring. The episode covers complications, normocalcemic primary hypoparathyroidism, and normohormonal primary hyperparathyroidism.
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Managing Borderline High Calcium
- Recheck borderline high calcium levels multiple times, especially over different periods.
- Check PTH and PTHRP levels if high calcium persists, even if it occasionally dips into the normal range.
Primary Hyperparathyroidism Diagnosis
- Elevated PTH with elevated calcium, even with thiazide diuretics, likely indicates primary hyperparathyroidism.
- Dietary calcium or supplements rarely solely cause significant hypercalcemia.
Vitamin D Management in Primary Hyperparathyroidism
- In primary hyperparathyroidism, low vitamin D is often secondary to elevated PTH.
- Replete vitamin D to 30-50 ng/mL to mitigate post-parathyroidectomy hypocalcemia.