Background: Primary hyperparathyroidism (PHPT) is a common endocrine disorder which affects 3/1000 of the general population and is associated with excess morbidity and mortality. Clinical practice tends to vary in terms of investigations, monitoring, decisions on intervention, and follow up. Audits in several European countries have previously demonstrated marked variation and divergence from best practice recommendations.
Methods: This project used the 2009 Third International Workshop guidance on the management of asymptomatic primary hyperparathyroidism in order to compare how patients were worked up, investigated and treated for their confirmed diagnosis of PHPT. It was a retrospective, multi-centre audit co-ordinated by the YDEF, with a clear audit process, inclusion, and exclusion criteria.
Results: Demographics 85% of patients with confirmed PHPT were female. Baseline investigations such as renal function, urinary calcium collection, abdominal imaging, three sites DEXA bone scanning varied both between and within individual centres. Indications for surgery were not always consistent and 14% who would not qualify for parathyroidectomy according to the guidance, did have an operation. Diagnostic imaging parathyroid imaging was requested as part of the diagnostic work up in 82.5% of patients, despite this not being indicated in the initial diagnosis of the condition. Sestamibi and/or USS correctly identified the location of parathyroid pathology in 63%.
Conclusions: Clinical practice varies throughout the UK and appears to deviate from the 2009 guidance. Criticisms of the guidelines are multiple and have been partially addressed in the latest 2014 version.