Introduction: Primary hyperparathyroidism (PHPT) affects 0.3% of the population. It is characterised by hypercalcaemia with an inappropriately high parathyroid hormone level. The majority of patients with primary hyperparathyroidism are asymptomatic and are diagnosed following an incidental finding of hypercalcaemia. Symptomatic disease is related to hypercalcaemia and can present with complications such as renal calculi and osteoporosis. Parathyroidectomy is the treatment of choice for patients with symptomatic PHPT and for asymptomatic patients who meet surgical criteria. Preoperative localisation of the parathyroid adenoma with techniques including ultrasound, sestamibi scanning, technetium-labelled single photon emission CT, plain CT and MRI is desirable. Since diagnosis is made on the basis of biochemical results, these imaging techniques need only be carried out if surgery is planned and are not required in patients who will be managed conservatively or medically. In December 2008, we produced guidelines for the diagnosis and investigation of PHPT which stated that imaging should only be carried out in patients who were being considered for parathyroidectomy. We audited the investigation of PHPT patients attending our endocrine service before and after the introduction of this protocol.
Methods: 47 cases of confirmed primary hyperparathyroidism were reviewed. 22 cases first attended the endocrine clinic before the protocol was introduced and 25 patients were seen once the protocol was in use.
Results: Prior to the introduction of the protocol, 5 patients who were not considered for parathyroidectomy had imaging studies, comprising 3 ultrasound scans, 4 sestamibi scans, 1 CT and 1 MRI scan. Since the protocol has been in use, 2 patients who are not being considered for surgery have had localisation scans - 2 ultrasounds and 1 sestamibi scan.
Summary: The introduction of a guideline for the imaging of patients with PHPT has resulted in a reduction in the number of inappropriate localisation studies being carried out.
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.