Bone health ECHO case report: Normocalcemic hyperparathyroidism in a patient with osteoporosis referred for pre-operative bone health evaluation before spine surgery

Primary hyperparathyroidism can be divided into three clinical phenotypes: classical primary hyperparathyroidism with hypercalcemia and target organ involvement, asymptomatic primary hyperparathyroidism with hypercalcemia, and normocalcemic primary hyperparathyroidism. The latter phenotype is being increasingly recognized in patients having serum parathyroid hormone levels measured as part of the initial evaluation of osteoporosis. The diagnosis of normocalcemic primary hyperparathyroidism requires exclusion of secondary causes of parathyroid hormone elevation, such an vitamin D deficiency and calcium malabsorption. There is no consensus on the management of patients with normocalcemic primary hyperparathyroidism, particularly with regard to consideration of parathyroid surgery versus clinical observation. This is a case report of a patient with persistently normal calcium levels, high parathyroid hormone, and no recognized cause of secondary hyperparathyroidism. This case was presented and discussed at Bone Health Extension for Community Healthcare Outcomes, a virtual community of practice that has been meeting online weekly since 2015.