Diagnosis of asymptomatic primary hyperparathyroidism: proceedings of the third international workshop

J Clin Endocrinol Metab. 2009 Feb;94(2):340-50. doi: 10.1210/jc.2008-1758.


Objective: Asymptomatic primary hyperparathyroidism (PHPT) is a common clinical problem. The purpose of this report is to guide the use of diagnostic tests for this condition in clinical practice.

Participants: Interested professional societies selected a representative for the consensus committee and provided funding for a one-day meeting. A subgroup of this committee set the program and developed key questions for review. Consensus was established at a closed meeting that followed. The conclusions were then circulated to the participating professional societies.

Evidence: Each question was addressed by a relevant literature search (on PubMed), and the data were presented for discussion at the group meeting.

Consensus process: Consensus was achieved by a group meeting. Statements were prepared by all authors, with comments relating to accuracy from the diagnosis subgroup and by representatives from the participating professional societies.

Conclusions: We conclude that: 1) reference ranges should be established for serum PTH in vitamin D-replete healthy individuals; 2) second- and third-generation PTH assays are both helpful in the diagnosis of PHPT; 3) DNA sequence testing can be useful in familial hyperparathyroidism or hypercalcemia; 4) normocalcemic PHPT is a variant of the more common presentation of PHPT with hypercalcemia; 5) serum 25-hydroxyvitamin D levels should be measured and, if vitamin D insufficiency is present, it should be treated as part of any management course; and 6) the estimated glomerular filtration rate should be used to determine the level of kidney function in PHPT: an estimated glomerular filtration rate of less than 60 ml/min.1.73 m2 should be a benchmark for decisions about surgery in established asymptomatic PHPT.

Publication types

  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Avitaminosis / blood
  • Avitaminosis / complications
  • Avitaminosis / diagnosis
  • Consensus*
  • DNA Mutational Analysis / methods
  • Diagnostic Techniques, Endocrine / standards
  • Humans
  • Hyperparathyroidism, Primary / complications
  • Hyperparathyroidism, Primary / diagnosis*
  • Hyperparathyroidism, Primary / genetics
  • Parathyroid Hormone / blood
  • Proto-Oncogene Proteins / genetics
  • Receptors, Calcium-Sensing / genetics
  • Vitamin D / blood


  • CASR protein, human
  • MEN1 protein, human
  • Parathyroid Hormone
  • Proto-Oncogene Proteins
  • Receptors, Calcium-Sensing
  • Vitamin D