Not sure how many have read this yet but I'd like to make raise some points for discussion...(I reviewed the literature on this last month for our own clinicians).
Typo in section 1.1.8
seek specialist advice.... if the PTH is "below the mid point of the reference range" with an adjusted calcium >=2.6
-should be "above"
More importantly the advice on spot urines.
The paper quite rightly refers to Chrisstensons paper in 2018 as the only paper that compares calcium excretion indices in genetically and surgically proven cohorts of FHH and hPTH. This paper used 24 hr urines and the indices included ca/cr ratio on a 24 hr urine.
The expert panel then state that you can use spot urines and the evidence summary describes the evidence level as 'they felt' that there would be no difference between spot & 24 hr urine ca/cr ratios. There is direct evidence against this statement published by Cegla in 2010: using a credible cohort of patients and a review of the literature published by A Jones in Osteoporosis International 2012 . As well as numerous papers that show correlations but which are not clinically usable to exclude hypercalciuria. There is ample scientific evidence that ca/cr ratio in spot urines varies with creatinine level, fasting status and time of day etc etc
I have looked at this quite hard as spot urine measurements would be more convenient.
Given the strength of the evidence against the use of spot urines the reliance on 'felt' is entirely disappointing
I would advise caution regarding accepting this statement at face value
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