STUDY OF PRIMARY HYPERPARATHYROIDISM IN UROLOGY

II. STUDIES OF LABORATORY TESTS FOR DIAGNOSIS OF PRIMARY HYPERPARATHYROIDISM

Abstract

The diagnosis of primary hyperparathyroidism is very difficult because of following reasons: the tumor of the parathyroid gland cannot be palpable; hypercalcemia, hypophosphatemia, hypercalciuria and hyperphosphaturia are not always specific complications of this disease; and the serum parathyroid hormone cannot be estimated. From these points of view, we must wait for the accumulation of more accurate laboratory evidences before we try to incise the neck which is quite independent to the urinary tract, and for this purpose various laboratory tests are employed.
In this paper, the results of various laboratory clinical tests for diagnosis of this disease are discussed, comparing with the other control groups, and the simplified method for the determination of theoretical renal phosphorus threshold (TRPT) was introduced.
From the results of laboratory tests, I conclude that it is the best way for screening the patient with primary hyperparathyroidism to perform these tests in regular order of following three stages:
1. The First Stage
a) Clinical signs
b) Determination of serum calcium and phosphorus levels
c) Determination of urinary calcium and phosphorus excretions
2. The Second Stage
a) Urine concentration test
b) Estimation of % TRP
3. The Third Stage
a) Calcium tolerance test
b) Calculation of parathyroid index
c) Determination of theoretical renal phosphorus threshold