Endocrine Abstracts

Introduction: Primary hyperparathyroidism (PHPT) can only be cured by parathyroidectomy (PTX) but mild and asymptomatic cases can often be managed conservatively. We carried out a retrospective audit of patients attending the Endocrine clinic at Watford to determine how our practice compared with the different guidelines for surgical referral published in the USA and the UK.

Method: A search was carried out of clinic letters from Jan 2010 to Oct 2011. Additional data were gathered from the hospital biochemistry results system. We determined the number of patients who fulfilled either of two sets of criteria for surgery and whether this had taken place. UK indications for PTX were: serum calcium >3.0 mmol/l, renal calculi, acute pancreatitis, age <50 years, osteoporosis at hip or spine, and 24-h urine calcium excretion >10 mmol/day. USA surgical criteria for asymptomatic PHPT were serum calcium >2.8 mmol/l, GFR <60 ml/min, osteoporosis and age as above.

Results: Ninety-seven patients were identified with PHPT. Thirty-two of these patients were referred for PTX. Fifty-five patients had indications for surgery according to UK guidelines and 29 of these (53%) had so far been referred. Of those not referred the indication for surgery in 16 was osteoporosis only. Seventy-one patients fulfilled USA criteria for PTX and 31 of them (44%) had been referred. Twelve patients not yet submitted to PTX had a GFR <60 ml/min. Mean age of all patients not referred was 72.6 years.

Conclusion: Our practice in this cohort was relatively conservative. Approximately half of patients who fulfilled some criterion for surgery (USA or UK) had not been referred. Reasons for this included age, stable disease, co-morbidities and patient choice. Further explanation from retrospective analysis will be available and a prospective audit is also underway.