Hyperparathyroidism (primary) NICE guideline: diagnosis, assessment, and initial management

Parathyroid hormone (PTH) is secreted from four parathyroid glands situated behind the thyroid gland. PTH regulates calcium and phosphate levels by its promotion of phosphate excretion and calcium reabsorption in the kidneys; stimulation of osteoclastic activity in the bone resulting in raised serum calcium; and increased intestinal absorption of calcium. Hyperparathyroidism is excessive secretion of PTH and can be primary, secondary, or tertiary: This article summarises the new National Institute for Health and Care Excellence (NICE) guideline for the diagnosis, assessment, and initial management of primary hyperparathyroidism (PHPT).2 This article highlights areas of particular importance for primary care. The causes and management of hypercalcaemia outside of the diagnosis and management of PHPT are beyond the scope of this article. The signs and symptoms of PHPT are predominantly brought about by hypercalcaemia and include thirst, increased …