Background: Primary hyperparathyroidism (PHPT) is a common condition, which in some patients can lead to complications such as osteoporosis and renal stones. This survey investigated diagnosis and treatment strategies for PHPT across Europe.
Methods: The survey was conducted in five European countries (France, Germany, UK, Italy and Spain). 286 of the 421 interviewed physicians were endocrinologists; the remainder were rheumatologists (46), internists (50) and urologists (39). Survey topics included: perception of the severity of the disease, referral for parathyroidectomy (PTX), diagnosis and treatment.
Results: Diagnostic methods were similar across Europe with serum PTH and serum calcium being the most common diagnostic tests (>94% of cases). Urinary calcium was measured in 8090% of patients. About 50% of physicians in each country followed national guidelines for treatment. Most physicians (66%) thought that not treating PHPT has serious implications. PTX was considered to be the therapy of choice for symptomatic patients by most respondents (77%). About half of the respondents (53%) recommended surgery in asymptomatic patients only if they meet specific criteria. 37% delayed surgery where possible and conducted regular follow-ups and/or treated pharmacologically. The respondents reported that about 43% of PHPT patients did not wish to undergo surgery and in 28% contraindications to surgery were identified. The respondents reported that approximately 10% of patients had a failed PTX. Regarding the pharmacological treatment, about half of all PHPT patients (49%) received bisphosphonates in combination with a diuretic (17%); about 13% had received a calcimimetic and 18% hormone-replacement therapy. Physicians in Italy (32%) and UK (28%) were more likely to treat asymptomatic patients pharmacologically than those in Spain (14%), France (14%) and Germany (13%).
Conclusion: The survey has demonstrated that although the approach to diagnosis of PHPT is similar across Europe, there are some notable differences in the pharmacological treatment of asymptomatic patients.
Prague, Czech Republic
24 - 28 Apr 2010
European Society of Endocrinology