- Primary hyperparathyroidism: parathyroid surgery is the treatment of choice in most symptomatic patients. Medical management is used for those for whom surgery is not suitable. Cinacalcet is occasionally used, under specialist supervision only. Refer to NICE guideline NG132.
- Secondary hyperparathyroidism: medical management is the mainstay of treatment and the underlying condition needs to be treated.
- Cinacalcet is approved for specialist use in renal patients with secondary hyperparathyroidism, who have uncontrolled plasma levels of parathyroid hormone (greater than 85 picomol/litre), that is refractory to standard therapy and in whom surgical parathyroidectomy is not suitable. A shared care guideline for cinacalcet is available here.
- All patients with severe hypercalcaemia (>3mmol/l) should be referred for urgent specialist input.