Primary Hyperparathyroidism
What Is It?
Excess PTH production by one or more parathyroid adenomas (most common) leading to hypercalcemia. Often asymptomatic but can cause kidney stones, osteoporosis, fatigue, cognitive impairment, and GI symptoms.
How Is It Diagnosed?
Elevated serum calcium + inappropriately elevated or high-normal PTH. 24-hour urine calcium. Renal ultrasound. DEXA scan for bone density. Imaging (sestamibi scan, ultrasound neck) to localize adenoma.
How Is It Treated?
Surgical parathyroidectomy is curative and recommended for symptomatic patients or asymptomatic with hypercalcemia >1 above normal, kidney stones, DEXA T-score <= -2.5, age <50. Cinacalcet for patients not surgical candidates.
Tests and Imaging Typically Needed
Serum calcium, PTH, phosphorus, 24-hour urine calcium/creatinine, BMP, vitamin D, DEXA scan, neck ultrasound, sestamibi scan.
Approximate Self-Pay Costs
Office visit: $95-$150. PTH and calcium: $30-$60. DEXA: $100-$200. Endocrinology and surgery referral.