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J Clin Endocrinol Metab. 2014 Oct;99(10):3570-9. doi: 10.1210/jc.2014-1414. Epub 2014 Aug 27.

Diagnosis of asymptomatic primary hyperparathyroidism: proceedings of the Fourth International Workshop.

Author information

  • 1Academic Unit of Bone Metabolism (R.E.), University of Sheffield, Sheffield S5 7AU, United Kingdom; University of Florence (M.L.B.), 50133 Florence, Italy; Department of Medicine (A.G.C.), Division of Endocrinology, Metabolic Bone Diseases Unit, College of Physicians and Surgeons, Columbia University, New York, New York 10032; Department of Medicine (A.G.C.), Division of Endocrinology, São Paulo Federal University, São Paulo 04021-001, Brazil; Centre Hospitalier de l'Université de Montréal (P.D.), Hôpital St-Luc and Department of Medicine, University of Montréal, Montréal, Québec, Canada H3C 3J7; Endocrine Research Unit (D.M.S.), San Francisco Department of Veterans Affairs Medical Center, University of California, San Francisco, California 94121; and Academic Endocrine Unit (R.V.T.), Radcliffe Department of Medicine, University of Oxford, Oxford OX3 7LJ, United Kingdom.

Erratum in

  • Erratum. [J Clin Endocrinol Metab. 2015]



Asymptomatic primary hyperparathyroidism (PHPT) is a common clinical problem. The purpose of this report is to provide an update on the use of diagnostic tests for this condition in clinical practice.


This subgroup was constituted by the Steering Committee to address key questions related to the diagnosis of PHPT. Consensus was established at a closed meeting of the Expert Panel that followed.


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


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.


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) normocalcemic PHPT is a variant of the more common presentation of PHPT with hypercalcemia; 4) serum 25-hydroxyvitamin D concentrations should be measured and, if vitamin D insufficiency is present, it should be treated as part of any management course; 5) genetic testing has the potential to be useful in the differential diagnosis of familial hyperparathyroidism or hypercalcemia.

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