Endocrine Abstracts

Aim: We performed a retrospective analysis to evaluate the surgical treatment of primary hyperparathyroidism in a tertiary referral centre.

Methods: We reviewed the case notes of 80 patients who underwent parathyroid surgery (2003 to 2011). Patients were identified from the national BAETS audit.

Results: Median age was 56 years (range 25–86). 72.5% of the patients were females and 30% were asymptomatic. Mean adjusted calcium concentration was 2.94 mmol/L and mean eGFR 79.6 ml/min/m². 55% patients had a renal ultrasound, 100% patients who presented with renal stones had an ultrasound. A weekly joint surgical-endocrine clinic was set up in 2008. Prior to 2008, vitamin D was tested in 17.1% and DEXA done in 40% cases. After 2008 vitamin D and DEXA were done in 53.3% and 53.3% cases respectively. In most cases, these had been undertaken at the referring hospital. Ultrasound findings correlated with the operative findings in 77.2% cases (n=61) while sestamibi correlated in 71.8% cases (n=56). 59.7% cases showed concordance between USS and sestamibi and 97.8% of these cases showed concordance with the surgical findings. Ultrasound had a sensitivity of 79.2% and a positive predictive value (PPV) of 93.8%, for sestamibi the corresponding figures were 73.7% and 91.8% respectively. Both the tests combined together had a sensitivity of 91% and a positive predictive value of 97.3%. There were no cases of recurrent hypercalcemia after surgery.

Conclusion: The dedicated clinic improved the diagnostic workup of patients, particularly with respect to vitamin D and DEXA scan assessment. The sensitivity of sestamibi is lesser than stated in literature, however the sensitivity and PPV for ultrasound scanning are similar to those quoted in a recent meta-analysis (1).

Reference: 1. Cheung K et al. 2011. A meta-analysis of pre-operative localization techniques for patients with primary hyperparathyroidism. Ann Surg Oncol Jun 28.

Declaration of interest: There is no conflict of interest that could be perceived as prejudicing the impartiality of the research reported.

Funding: No specific grant from any funding agency in the public, commercial or not-for-profit sector.