Normocalcemic Hyperparathyroidism

Jack M. Monchik, MD, FACS

Hypercalcemia as manifested by an elevated total serum calcium has traditionally been an important parameter in the diagnosis of primary hyperparathyroidism (PHPT). Initial studies of patients with PHPT stressed the rather constant elevation of the total serum calcium in this entity. Intermittent or no elevation of the total calcium was considered to be rare, if not impossible.13 Subsequent reports have identified patients with PHPT with subtle hypercalcemia defined as intermittent, minimal, or no elevation of the total calcium. For the purpose of this chapter, these patients are considered to have normocalcemic hyperparathyroidism. Most of these patients have renal stone disease and, to a much lesser degree, skeletal abnormalities.4 7 The introduction of bone densitometry with dual energy x-ray absorptiometry (DEXA) scans for screening for osteoporosis has identified an additional group of patients with normocalcemic hyperparathyroidism. This diagnosis of normocalcemic hyperparathyroidism is a challenge that must be considered in all patients with metabolic complications of PHPT. Solving this diagnostic problem is dependent on an understanding of calcium metabolism.

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