Aims and Objectives: We conducted a study of 71 patients with Primary Hyperparathyroidism being managed in a single site Joint Endocrine Service. We sought to review the adherence to current international guidelines in managing these cases, and the effectiveness of pre-operative localization to inform surgical options.
Results: A total of 71 cases were reviewed, of whom 35 were managed conservatively and 36 underwent surgery. Every patient undergoing surgery had corrected endocrine diagnosis. In the group of patients with calcium more than 3.0 mmol/L, 91.3% underwent surgery, 2.9% declined surgery, 2.9% were missed and another 2.9% were lost in follow up. 50% cases had mini/ unilateral exploration and 50% 4-gland exploration, all successfully predicted by ultrasound and sestamibi pre-screening. In 90% cases the surgical findings matched the histological findings, though every patient operated on achieved post-op eucalcaemia. The group of patients managed conservatively did not have any significant change in calcium levels over a 2 year follow-up. 84% were adenomas, 16% hyperplasia and there were no cases of parathyroid carcinoma. Two patients needed thyroid lobectomy of which one also identified a follicular thyroid carcinoma. Only 28% patients had DEXA bone scan and 43.7% patients had renal calcium excretion checked, which was the principal cause for the 2.9% missed surgical rate.
Radiological corelation with Surgical findings
Conclusion: We report the benefit of an effective multidisciplinary service for the management of primary hyperparathyroidism. We confirmed an appropriate selection of cases for surgery, supported by pre operative radiological localisation. More efforts are needed on screening for asymptomatic bone and renal complications as recommended by international guidelines.
Declaration of interest: There is no conflict of interest that could be perceived as prejudicing the impartiality of the research reported.
Funding: No specific grant from any funding agency in the public, commercial or not-for-profit sector.