Endocrine Abstracts

Primary hyperparathyroidism is a common endocrine disorder. Diagnosis is more frequently made where calcium testing forms part of routine screening bloods. The clinical profile has shifted from a symptomatic disorder with hypercalcaemic symptoms, kidney stones and overt bone disease towards a more asymptomatic state. The National Institutes of Health (NIH) have produced guidelines on diagnosis and management of primary hyperparathyroidism but no UK guidelines are in existence.

We conducted a local audit into the diagnosis and management of primary hyperparathyroidism to ascertain the extent to which management differed from the NIH guidelines. Forty-eight patients with primary hyperparathyroidism diagnosed between 1980–2006 were identified (male:female – 1:4.9).

The NIH guidelines recommend ultrasound and/or sestamibi scanning for operative planning and these were performed in 73% (13/48) and 42% (20/48) of patients respectively. According to the NIH guidelines all patients should undergo DEXA scanning but only 25% (12/48) of our patients underwent DEXA scanning of which 11 (92%) were found to have osteoporosis or osteopenia.

About 24/48 (50%) patients underwent parathyroidectomy. When the NIH guidelines were applied retrospectively no patient had undergone surgery without meeting the guideline criteria. Of those patients that underwent parathyroidectomy 17/24 (70%) were found to have a parathyroid adenoma. All but 2 patients were cured and there was no significant mortality or morbidity.

This audit has highlighted local variance in management of primary hyperparathyroidism in relation to NIH guidelines although patients proceeding to surgery meet the recommendations outlined in the guidelines. We feel that this audit illustrates a role for local guidelines.