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Evidence-Based Primary hyperparathyroidism surgery criteria aace aaes Scoring

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CLINICAL REFERENCE

CLINICAL INSIGHT

When to Use

Evaluating patients with biochemically confirmed Primary Hyperparathyroidsm (PHPT).
Determining if an "asymptomatic" patient should proceed to parathyroidectomy.
Adhering to the Fifth International Workshop guidelines on Asymptomatic PHPT.

CLINICAL INSIGHT

How it Works

Biochemical / Age Thresholds

Parameter	Threshold for Surgery
Serum Calcium	> 1.0 mg/dL above ULN (> 2.8 mmol/L)
Age	< 50 years
T-score (DXA)	≤ -2.5 (Spine, Hip, or Distal Radius)
Vertebral Fracture	Presence of fracture on XR, CT, MRI, or VFA

Renal Criteria

Creatinine Clearance / eGFR < 60 mL/min.
24-hour urine calcium > 400 mg/day (or ethnicity-adjusted high).
Presence of Nephrolithiasis or Nephrocalcinosis on imaging.

CLINICAL INSIGHT

Practical Pearls

Distal Radius Importance

Hyperparathyroidism preferentially affects cortical bone. The 1/3 (Distal) Radius is highly cortical, so DXA of this site is often the first to show osteoporosis in PHPT and is a formal criterion for surgery.

Silent Stones

The most recent guidelines emphasize that "asymptomatic" patients should undergo renal imaging (US or CT) and vertebral fracture assessment (VFA). If silent stones or fractures are found, they are no longer asymptomatic and should be offered surgery.

CLINICAL INSIGHT

Evidence Base

Primary Source

Guidelines for the Management of Asymptomatic Primary Hyperparathyroidism: Summary Statement from the Fifth International Workshop.

Bilezikian JP, et al.J Bone Miner Res2022

When to Use

When to Use

How it Works

Biochemical / Age Thresholds

Renal Criteria

Practical Pearls

Distal Radius Importance

Silent Stones

Evidence Base

Primary Source

Primary Hyperparathyroidism Surgery Criteria (AACE/AAES)

When to Use

When to Use

How it Works

Biochemical / Age Thresholds

Renal Criteria

Practical Pearls

Distal Radius Importance

Silent Stones

Evidence Base

Primary Source

Primary Hyperparathyroidism Surgery Criteria (AACE/AAES)

Clinical Evidence and Methodology

When to Use

When to Use

How it Works

Biochemical / Age Thresholds

Renal Criteria

Practical Pearls

Distal Radius Importance

Silent Stones

Evidence Base

Primary Source

Primary Hyperparathyroidism Surgery Criteria (AACE/AAES)

Clinical Evidence and Methodology

When to Use

When to Use

How it Works

Biochemical / Age Thresholds

Renal Criteria

Practical Pearls

Distal Radius Importance

Silent Stones

Evidence Base

Primary Source

Primary Hyperparathyroidism Surgery Criteria (AACE/AAES)