Primary hyperparathyroidism (PHPT) is a common reason for referral to the endocrinology team. We aimed to estimate the prevalence of associated vitamin D deficiency and osteoporosis, to evaluate the usefulness of imaging studies in identifying a parathyroid adenoma prior to surgery and to assess response to surgical treatment in the setting of a District General Hospital.
We searched our outpatient clinic letters and identified 64 patients diagnosed with PHPT between July 1996 and May 2009. Thirty-four (53.1%) patients were of white British ethnic origin and 3 (4.7%) were of Asian Pakistani origi. Mean age (±S.D.) was 61.0 (±13.7) with 50 patients under the age of 50. The mean (±S.D.) highest recorded calcium was 2.95 (±0.19) mmol/l. Eleven patients had a calcium level above 3 at diagnosis and during follow-up the level rose above 3 in 20 patients. Vitamin D levels were measured in 44 patients: 11 (25%) had levels between 10 and 15 μg/l and 9 (20%) levels below 10 μg/l. Bone densitometry scans were done in 22 patients: 7 (31.8%) had osteopaenia and 12 (54.5%) had osteoporosis. The age range of patients with osteoporosis was 3886 (mean 63).
Twenty-three patients received surgical treatment (4 in our hospital, 17 in a tertiary referral centre and 2 elsewhere). Following surgery 21 (91.3%) patients had normal calcium levels. In 5 patients in whom we could correlate the report of a Tc sestamibi scan with surgical findings an adenoma was correctly identified in 2 (40%) patients by the isotope scan. Neck ultrasound correctly identified an adenoma in 3 (60%) of patients.
In our cohort of patients with primary hyperparathyroidism there was a significant incidence of vitamin D deficiency and osteoporosis. Based on our data we think screening for these conditions is advisable in patients being assessed for PHPT.