Introduction: Primary hyperparathyroidism (PHPT) is a relatively frequent problem presenting with hypercalaemia detected on a routine blood test. All PHPT patients should have a urine calcium concentration, DEXA scan and vitamin D level checked at the time of diagnosis. Vitamin D supplementation aims to achieve a vitamin D level over 50 nmol/l which may be associated with positive outcomes such as a lower serum parathormone (PTH), calcium and alkaline phosphatase concentration and decreased bone turnover.
Aim: We conducted a retrospective observational study into the diagnosis and management of primary hyperparathyroidism and the evaluation and replacement of vitamin D deficiency in this group to determine compliance with national guidelines.
Method: PHPT patients were identified from the pathology database as those with hypercalcemia and a normal or inappropriately high PTH with no concomitant renal impairment. 67 patients were identified. Further data was collected from patient records, biochemistry results and radiology reports.
|Urinary calcium creatinine at diagnosis||Vitamin D level checked at diagnosis/vitamin D level checked at any time||DEXA scan||Radiological imaging (ultrasound scan/Sestamibi scan) prior to surgery|
|Performed?||n=41 (71%)||n=4//54 (60%/ 82%)||n=50 (86%)||n=16 (100%)|
|Results||71% deficient (33% achieved repletion of which 58% maintained vitamin D levels)||Significant improvement in PTH and no serum (calcium) change with vit D treatment compared to no vit D treatment||66% hip osteopenia or osteoporosis (mean hip T score −1.37)||68% spine osteopenia or osteoporosis (mean spine T score −1.55)|
Conclusion: The diagnostic work-up for PHPT needs to be improved to achieve full compliance with national guidelines. This could be achieved with the use of an out-patient proforma and requesting a panel of bloods (e.g. PHPT Panel) rather than individual tests. Vitamin D supplementation is beneficial for the treatment of PHPT.