The serum phosphate level can help in diagnosis. Phosphate concentrations are high or normal in hypercalcemia due to most other causes, including secondary hyperparathyroidism in renal failure. Medical treatment of primary hyperparthyroidism should be considered only temporizing. Patients who are not surgical candidates because of concurrent illness or short life expectancy can be treated with bisphophonates, although this may take up to three days to be effective. Calcitonin, glucocorticoids, and hemodialysis can be helpful while waiting for bisphosphonates to work or for stabilizing the patient prior to surgery.
Surgery can cure hyperparathyroidism.
Operation is indicated in patients with severe consequences of hyperparathyroidism such as recurrent kidney stones, hyperparathyroid bone disease, and, as in our patient, severe hypercalcemia. However, because so many mild cases of hyperparthyroidism are discovered on testing of asymptomatic patients, the consensus statement also lists laboratory indications for operation. In addition, patients need radiographic search for kidney stones or nephrocalcinosis, and bone mineral density measurement. A careful history is essential to ascertaining whether patients are symptomatic or not. The presence of hypertension or peptic ulcer disease is not an indication for surgery.