Endocrine Abstracts

In 2008, we presented data showing that combining sonography and scintigraphy investigations resulted in the correct identification of a parathyroid adenoma in 97% (28/29) patients undergoing parathyroid surgery for primary hyperparathyroidism (PHPT). Further to this audit we compared the treatment of PHPT against the standards set by NIH in 2008. All patients who had Setamibi +/ ultrasound scan over 18 month (July 2006 until December 2007) for biochemically confirmed PHPT were audited. Of a total of 92 patients who had either one or both scans, 42% (39/92) had surgical removal of the adenoma. The remaining 58% (53/92) were not operated on.

We further analysed the ‘not operated’ subgroup to assess for end-organ damage secondary to PHPT. Twenty-three percent (12/53) had osteoporosis, 43% (23/53) had no DEXA scan and the remaining 34% (26/53) had either normal bone density or osteopaenia. Also, 43% (23/53) had no imaging to detect renal calculi, 51% (27/53) had normal imaging and 6% (3/53) had renal calculi on imaging.

In addition, patients in the ‘not operated’ subgroup did not have surgery for several reasons:

We also noted that 3 patients had parathyroid imaging which was requested by a general physician.

Our audit highlights several recommendations:

i)Jointly agreeing a single clinical pathway for the investigation and treatment of PHPT to reduce unnecessary investigations and referrals if patient not fit or unwilling for surgery

ii)Set up ‘Joint’ parathyroid clinic with endocrine surgeon.

iii)Parathyroid imaging to be requested by a specialist endocrinologist only.

iv)Parathyroid surgery to be done only by a single experienced surgeon.

The audit will be repeated in 1 year after the above recommendations have been implemented.