Introduction: Primary hyperparathyroidism (PHPT) is a clinical condition often recognized as a result of biochemical screening. While surgery is indicated in symptomatic hypercalcaemic states, the need and timing of surgery in asymptomatic patients is not always clearcut. We conducted a retrospective audit on the diagnosis and management of primary hyperparathyroidism between the years 2010 and 2014.
Method: Patients were identified through our histopathology, surgery, and endocrine database.
Results: Ninety-six patients diagnosed with primary hyperparathyroidism were identified. (81% females and 19% males). Mean age of the cohort is 68, with 13% under the age of 50. 58% have 24 h urinary calcium measurement, 81% have vitamin D level measurement, and 57% have a baseline DEXA assessment. 68 patients (71%) were referred for parathyroidectomy. 51% of these referred patients were symptomatic with calcium level above 2.85 mmol/l, 26% of the patients were asymptomatic with calcium above 2.85 mmol/l and 21% of the patients were asymptomatic with calcium level <2.85 mmol/l. In patients who had localization studies, ultrasound and sestamibi were not concordant in 53%. 31% of the adenomas were localized via other imaging modalities. Surgery was successful in 75% of the cases. 17/68 (25%) patients were not cured by surgery and five patients needed further revision of surgery. Histology confirmed adenoma in 74% of the cases. 8/68 (11%) had further complications post surgery (four had transient vocal cord palsy, one with hypothyroidism, two with hypocalcaemia, and one developed wound infection).
Conclusion: Majority of the patients were referred for surgery as per guidelines. 21% of asymptomatic individuals who do not meet surgical criteria were offered surgery. There is local variance in investigations for vitamin D, urinary calcium, and bone mineral density. Concordance rate of ultrasound and sestamibi imaging is poor and further consensus needs to be reached with regards to optimal imaging modalities.