Endocrine Abstracts

Background: Primary Hyperparathyroidism is a leading cause of hypercalcaemia and is frequently asymptomatic. Due to its long-term complications, early diagnosis and management is essential. NICE published guidelines on diagnosis and management of Primary Hyperparathyroidism in May 2019. The aim of this audit was to compare our existing practices against NICE guidance.

Methods: We conducted retrospective data collection by identifying patients diagnosed with Primary Hyperparathyroidism in the Endocrinology Outpatients at Darent Valley Hospital between January 2018 and June 2019. The patients’ symptoms, calcium levels, PTH levels, diagnostic tests and management were compiled into tabulated format and the relevant areas were analysed against NICE guidance to determine compliance.

Results: A total of 44 patients were identified as diagnosed with Primary Hyperparathyroidism in Endocrinology Outpatients. Of the 44 patients, renal function was checked in all 44, DEXA scan was done in 28, and renal tract ultrasound was done in 25. The compliance percentage of these practices was 100 %, 64 % and 57 % respectively. Urinary calcium excretion measurement to exclude FHH was done in 22 patients (50 %). 28 patients met the criteria for surgical referral and 23 of these were referred for surgery. 16 patients did not meet the criteria for surgery but 2 of these were referred for surgery.

Conclusion: The compliance against NICE recommendations was variable, which was expected as the audit was done to review practices prior to the guidelines. Renal function testing, symptoms review and surgical referrals were in accordance with guidelines. Urinary calcium measurement, renal imaging and DEXA scan should be incorporated into current practices.

Action Plan: FHH should be excluded in patients with suspected Primary Hyperparathyroidism by measuring urinary calcium excretion. Patients with confirmed Primary Hyperparathyroidism should have renal imaging and DEXA scans.

References: National Institute for Health and Care Excellence. (2019). Hyperparathyroidism (primary): diagnosis, assessment and initial management