Endocrine Abstracts

Background: Primary Hyperparathyroidism (PHPT) is the leading cause of hypercalcaemia. Early diagnosis and management is important to prevent long term complications. National institute of clinical excellence (NICE) published guidelines on diagnosis and management of Primary Hyperparathyroidism and we sought to compare our practice with the NICE guideline (NG 132).

Methods: This was a retrospective observational study of patients diagnosed with PHPT between January 2017 and December 2021. Data collected included patients’ symptoms, calcium and parathormone (PTH) levels, diagnostic test results, management, and treatment outcomes.

Results: Twenty-four patients {mean age (range) 69 (34-87 years)} with a diagnosis of primary hyperparathyroidism were identified during the study period. Only 12/24 (50%) patients had symptoms consistent with hypercalcaemia. 9/24 (37.5%) patients had 24-h urinary calcium levels measured. Ten (41.7%) had renal tract ultrasound performed. Dual-energy x-ray absorptiometry (DEXA) was done in 23/24 (96%) patients and this revealed osteoporosis in 13/23 (56.5%) and osteopenia in 7/23 (30.4%). Nine (37.5%) patients were managed surgically, 10 (41.7%) medically. Majority (88.9%) of the surgically managed patients had normalisation of calcium levels compared to 30% patients managed medically (treatment with either bisphosphonate, cinacalcet or both). 29% patients’ management was fully compliant with NICE guidelines.

Conclusion: The compliance with NICE recommendations was variable. Measurement of 24-h urinary calcium excretion levels and renal tract ultrasound should be incorporated into routine practice. Parathyroidectomy seems to be associated with the best outcomes and should be considered, if possible, in all patients.