Endocrine Abstracts

An audit on hypercalcaemia. Tools of the trade

AN Arefin & C White

Pontefract General Infirmary, Pontefract, United Kingdom.

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Introduction: Primary hyperparathyroidism (PHP) is common; Prevalence and Incidence are now much higher than the past. There is also a change in practice related to medical management, surveillance, and defining criteria for diagnosis as well as the recommendation for surgery.

Objective: *To look at the management of hypercalcaemia at Pontefract General Infirmary among all medical specialities, especially with regards to Primary Hyperparathyroidism. *To raise the awareness of the current trend in the management of Asymptomatic Primary Hyperparathyroidism.

Methodology: Case notes study of 40 randomly selected cases of Hypercalcaemia over 12 months period and compare them against the Guidelines for parathyroid surgery in asymptomatic primary hyperparathyroidism – by Consensus Development Panel, NIH, USA: *Serum calcium (above ULN) >0.25 mmol/l; *24 h urinary calcium excretion >10 mmol/day; *Creatinine clearance reduced by 30%; *BMD t-score < −2.5 at any site; *Age <50 years.

Result: Gender split (n=40) 30% male, 70% female; Age range 35 to 93 years. Mean age 74 years. 16 case of confirmed Primary Hyperparathyroidism (n=16); age range: 1 (35 −50 years); 4 (51–70 years); 10 (71–90 years); 1 over 90 years.1 out of 16 had Sestamibi scan; 2 out of 16 had 24 h urinary calcium excretion measured; 4 out of 16 had Renal USS; 5 out of 16 had USS of neck; all of them had PTH but none of them had BMD measured. 11 of them had calcium range between 2.6–2.85 mmol/L; 4 had between 2.86–3.00 mmol/L; 1 had calcium above 3.00 mmol/L. Only 1 person had parathyroid surgery who was 69 & had Ca++ level of 3.03 mmol/L.

Conclusions:

1. Decision to send patients for surgery was considered primarily on their calcium level.

2. Other criteria for surgery were largely ignored.

3. End organ damages were vastly ignored as well.

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Endocrine Abstracts (2005) 10 P41