Endocrine Abstracts

Introduction: Guidelines have, for some time, suggested a lower threshold for surgical intervention in primary hyperparathyroidism based on serum calcium alone. Furthermore, PHPT is a common metabolic bone disorder which is associated with further complications. In order to assess the impact of the lower threshold on surgical services and management implications for associated complications, we report baseline characteristics in a cohort of patients with confirmed PHPT.

Method: Retrospective analysis of 125 patients to collect baseline data for corrected calcium (n=125), vitamin D (n=119), PTH (n=125), bone mineral density (BMD) of the lumbar spine (n=71) and neck of femur (NOF) (n=72), renal imaging (CT or US scan; n=83). Finally, we report the number of parathyroid US scans (n=62) and MIBI scans (n=57) demonstrating concordance.

Results: Mean (±S.D.) age was 64.8 (±16.5) years. Mean (±S.D.) corrected calcium, PTH, and vitamin D at baseline were 2.7 mmol/l (±0.21), 18.6 pmol/l (±10.2), and 32.3 nmol/l (±23.5) respectively.

The number of patients with serum calcium between 2.85 and 2.99 and >3.0 mmol/l was 14 and 20 respectively. Of those with vitamin D deficiency, 74 (60%) were deficient (<30 mmol/l), 25 (20%) were insufficient (30–50 mmol/l).

Of those scanned, DEXA demonstrated reduced BMD at the lumbar spine with 28 (39%) osteopenic and 14 (20%) osteoporotic. For NOF, 20 (28%) were osteopenic and 11 (15%) osteoporotic. Of 83 (66%) who had renal imaging, 18 (21.7%) demonstrated renal tract calcification.

62 (50%) underwent parathyroid ultrasound, 19 (31%) had an identifiable adenoma.

57 (46%) underwent a MIBI scan, 20 (35%) showed an adenoma.

10/57 (17.5%) patients had an adenoma on both.

Conclusion: Based on current guidelines, the number of referrals for surgical treatment on calcium levels alone has increased by 70%. Furthermore, assessment and treatment of complications prior to surgery, i.e. vitamin D deficiency, must be considered as well as follow-up of BMD/renal complications.