Endocrine Abstracts

To determine our adherence to the Consensus Development Conference on the Management of Asymptomatic Primary Hyperparathyroidism (2002) guidelines, we audited the management of all patients referred to our endocrine unit with the diagnosis of primary hyperparathyroidism during January 2003 to December 2004.

Overall 36 patients were referred. 32 were females and the mean age was 64 years.19 patients were Caucasians, 8 were Asians and 9 patients were of Afro-Caribbean origin. Mean corrected calcium was 2.84 mmol/l (normal range 2.2–2.6 mmol/l). Mean PTH level was 192 pg/l (normal range 10 65 pg/l). Parathyroidectomy was indicated in 5 patients, criteria being increasing calcium levels in 4 patients and development of symptoms related to hyperparathyroidism in 1 patient. Subsequently they were all referred for parathyroidectomy and 4 patients had their operation done.

At the initial assessment, all patients had their serum calcium, PTH and creatinine checked, 6/36 (16%) patients had their 24 hour urine calcium estimated, 16/36 (44%) had abdominal imaging done and 19/36 (52%) had their bone mineral (BMD) density measured at the hip and spine. None had their BMD measured at the radius. All patients were followed every 6 months and had their calcium and creatinine levels checked every 6 months according to guidelines. None had their bone density measured annually.

In conclusion, more emphasis is needed in measuring bone mineral density both at the initial assessment and annually thereafter (including at the radius). Only 44% of our patients had abdominal imaging (KUB or US) done, with the potential of missing asymptomatic renal calculi.