Subjective
Date of visit
Reason for visit (follow-up for primary hyperparathyroidism [PHPT], evaluation of new symptoms)
Current symptoms:
Bone-related symptoms (may not be present in all patients):
Bone pain or fractures
Joint pain or stiffness
Muscle weakness
Gastrointestinal symptoms:
Peptic ulcers (more common in PHPT)
Nausea, vomiting, constipation
Abdominal pain
Neurological symptoms (less common):
Fatigue
Difficulty concentrating
Depression or anxiety
Cognitive decline (in severe cases)
Kidney stones (a common complication)
Changes in urination or thirst (increased urination may occur)
Recent changes in medications or health
Family history of hyperparathyroidism (can be a risk factor)
Objective
Vital signs (temperature, blood pressure, heart rate) – elevated blood pressure may be present
Physical exam:
General (assessing for signs of bone deformities, muscle weakness)
Neurological exam (brief exam to assess for cognitive function and reflexes)
Laboratory Tests
Serum calcium: elevated in PHPT (diagnostic test)
Ionized calcium: may also be elevated
Parathyroid hormone (PTH): elevated and inappropriately high for the elevated calcium level (diagnostic test)
Serum phosphate: may be low in PHPT
Serum creatinine: to assess kidney function
Electrolytes (calcium, potassium)
Imaging Tests (may be ordered depending on clinical presentation):
Bone density scan (DEXA scan): to assess for bone mineral density and risk of fractures
Neck ultrasound or Tc-99m sestamibi scan: to localize parathyroid gland enlargement (helpful for surgical planning)
Assessment
Primary hyperparathyroidism confirmed (based on elevated calcium, PTH, and inappropriately high PTH for calcium level)
Severity of disease and presence of complications (bone disease, kidney stones)
Localization of enlarged parathyroid gland(s) (if imaging studies were performed)
Plan
Treatment plan based on severity of disease, symptoms, and patient preferences:
Watchful waiting: may be appropriate for asymptomatic patients with mild hypercalcemia
Surgery: curative approach, typically minimally invasive parathyroidectomy to remove the enlarged gland(s)
Medications: to lower calcium levels (used in some cases or for patients not surgical candidates)
Referral to a parathyroid surgeon (if surgery is planned)
Education
Explain primary hyperparathyroidism, a condition where the parathyroid glands produce too much PTH, leading to high calcium levels.
Discuss the treatment plan, potential risks and benefits of each option.
Importance of maintaining adequate hydration to prevent kidney stones.
Dietary modifications (may be helpful to lower calcium levels)
Importance of regular follow-up to monitor calcium levels and for potential complications.
Follow-up
Schedule for follow-up appointments:
Monitor calcium levels and electrolytes
Assess for response to treatment
Address any ongoing challenges or concerns
Screen for complications (bone density scans)
Disclaimer: This information is for educational purposes only and should not be interpreted as medical advice. Please consult with a qualified healthcare professional for diagnosis and treatment of primary hyperparathyroidism.