primary hyperthyroidism

Q: All of the following favor the diagnosis of primary hyperparathyroidism EXCEPT?

A) asymptomatic patient 

B) chronic hypercalcemia

C) postmenopausal status (females)

D) evidence of sarcoidosis

E) evidence of multiple endocrine neoplasia (MEN)

Answer: D

The objective of this question is to highlight the importance of skill of history taking. In hyperparathyroidism, etiology and level of hypercalcemia play an integral part in determining the urgency, further diagnostic workup and management. For example, hypercalcemia due to cancer is usually very high, symptomatic, urgent, and responsive. 

Evidence of sarcoidosis (choice D) makes it secondary hyperparathyroidism. Following are the usual features of primary hyperparathyroidism:

• an asymptomatic patient 
• mild or borderline chronic hypercalcemia
• a postmenopausal female
• usually a normal physical examination
• no cause of hypercalcemia 
• family history of hyperparathyroidism
• evidence of multiple endocrine neoplasia

#endocrinology

References:

1. Walker MD, Silverberg SJ. Primary hyperparathyroidism. Nat Rev Endocrinol. 2018 Feb;14(2):115-125. doi: 10.1038/nrendo.2017.104. Epub 2017 Sep 8. PMID: 28885621; PMCID: PMC6037987. 

2. Sun B, Guo B, Wu B, Kang J, Deng X, Zhang Z, Fan Y. Characteristics, management, and outcome of primary hyperparathyroidism at a single clinical center from 2005 to 2016. Osteoporos Int. 2018 Mar;29(3):635-642. doi: 10.1007/s00198-017-4322-7. Epub 2017 Dec 3. PMID: 29198075.