Endocrine Abstracts

Introduction: Primary hyperparathyroidism (PPTH) is a common referral to endocrine clinics with a clinical spectrum ranging from an asymptomatic state to a symptomatic disorder with or without end organ damage. We audited our management against the NIH guidelines which are endorsed by the Endocrine Society.

Methods: There is no outpatient coding system to correctly identify all patients with primary hyperparathyroidism. We included patient on radiology database who underwent imaging for the adenoma localization between April 2011 and March 2012.

Results: A total of 60 patients were identified, of which 68% were female. Mean age of the total cohort was 65 years. 12/60 (20%) were under 50 years of age and 48/60 (80%) were older than 50 years.

Only 23/60 (40%) had a 24 h urinary calcium measurement done and only 16/60 (27%) had a baseline DEXA assessment. Only 8/13 (62%) of those with a history of renal stones had a renal ultrasound (USG) with 8/45 (18%) with no history of renal stones had ‘routine USG’. 52/60 (87%) of the patients underwent both parathyroid ultrasound and Sestamibi scan for adenoma localization.

9/12 (75%) of patients age 50 years or less had surgery. Of the remaining 3/12 (25%), one was waiting for surgery, one opted for conservative approach and one moved out of the country. In those >50 years, 37/48 (77%) met the criteria for surgery; 11/48 (23%) did not meet surgical criteria. In the former group, 22/48 (42%) had surgery, 12/48 (25%) were deemed surgical high risk or declined after tests, 3/48 were awaiting surgical review. All 31/31 (100%) patients undergoing surgery were cured.

Conclusions: Our audit highlights local variance in management and the need to adhere to the guidelines. We plan to discuss this in clinical governance meeting and formulate a performa for appropriate investigations for primary hyperparathyroidism.