Endocrine Abstracts

Introduction: This audit was undertaken to determine whether Primary Hyperparathyroidism (PHPT) management in the clinical setting is compliant with the nine standards set of the existing PHPT pathway in the City Hospital Sunderland Foundation Trust (CHSFT). PHPT pathway was developed in (CHSFT) to allow effective management and surgical referral for this common condition in line with available national and international guidelines.

Methods: Data was retrospectively collected for 34 patients diagnosed with PHPT last year. A questionnaire based on these pathway nine standards was designed

Audit results: The study showed 100% compliance with the first three standards. 88% compliance with standard four. 93% compliance with standard five. In 82% of cases, MIBI scan was done first and end organ damage was excluded. In 79% of cases, ultrasound scan of the neck was performed, based on the MIBI scan results. 26% patients had concordant images and referred to the ENT, another 26% with non-concordant images underwent CT scan following discussion in the MDT. Overall, 46% patients underwent parathyroid surgery successfully, 35% were commenced on Cinacalcet due to surgical non-suitability and 18% were on regular monitoring as per patient choice and suitability.

Discussion: Compliance with our PHPT pathway was extremely good.This illustrated the great value of following the pathway and indicated the good compliance with the guidelines.The study showed the importance of MDT approach and the liaison with the surgical team in order to achieve the desired outcome. Since developing the pathway, our approach to management of Primary hyperparathyroidism has been streamlined. Surgical colleagues appreciate the uniformity in approach by the Endocrine team.This has resulted in fewer unnecessary scans and a more cost-effective approach,without compromising on quality. Although patient cohort audited was small, no benign familial hypocalciuric hypercalcaemia cases were detected in this audit. This will be re-audited to ensure maintenance of the standards.