Endocrine Abstracts

Background: Symptoms consistent with hypercalcaemia are an indication for surgery in patients with primary hyperparathyroidism (PHPT). However, symptoms can be subtle and may not be documented systematically. We analysed the documentation of symptoms in a large series of patients with PHPT, and the subsequent impact of introducing a symptom scoring questionnaire.

Methods: A standardised proforma was used to retrospectively analyse symptom documentation by clinicians for 339 new patients with PHPT between 2012 and 2017. We then prospectively collected self-rated symptom data for patients with PHPT using the validated Pasieka symptom questionnaire.

Results: Of 339 patients, 46% were documented as symptomatic at their initial visit. 35% had documentation about all symptom groups, but 17% had no documentation of any symptoms. In terms of symptoms by individual group, the following table demonstrates documentation pre-surgery:

For patients referred for surgery solely based on symptoms, 19% had documentation of all symptom groups, 81% had partial documentation. Post-surgery only 27% of 131 patients had documentation about all symptom groups. The Pasieka questionnaire has a threshold value of 200 (out of 1600) for a patient to be considered ‘symptomatic’. After introduction of this patient self-rated tool (n=68) we found a mean pre-surgery symptom score of 529 (range 0–1165), with 77% of patients scoring over the ‘symptomatic’ threshold.

Conclusion: This single-centre analysis in a large cohort of patients with PHPT, confirms poor symptom documentation by clinicians, particularly for neurocognitive symptoms, both pre and post-surgery. The use of a specific, symptom self-rating questionnaire captures a greater proportion of symptomatic patients than by clinician documentation alone. This suggests widespread implementation of such questionnaires may help to identify more patients who would benefit from surgery.