Background: The 3rd International Workshop on management of primary hyperparathyroidism (PHP) sets out clear criteria for parathyroidectomy (PTx) in patients with asymptomatic PHP: age < 50 years; osteoporosis or fracture; nephrolithiasis; corrected calcium >0.25mmol/l above reference range; creatinine clearance <60ml/min.
Clinical question: To determine the rate of PTx in patients with PHP in Southern California, USA fulfilling the criteria for PTx.
Study design: A retrospective analysis of an electronic database containing 3 million people was performed (Ann Surg. 2012; 255(6): 1179-83). Multivariate logistic regression was used to examine predictors of PTx. PHP was defined as raised serum calcium and PTH without evidence of renal disease. The study therefore could not conclusively exclude rare disorders such as familial hypocalciuric hypercalcaemia.
Findings: Approximately 3000 patients were assigned a diagnosis of PHP. 40% of patients with PHP fulfilled at least one criterion for PTx, and this proportion increased after 2002 to 50% with relaxation of guideline on bone mineral density. Only 40% of patients fulfilling at least 1 criterion for PTx, actually received PTx. Comorbidity and increased serum creatinine were two factors associated with lower likelihood of PTx.
Imperial Centre for Endocrinology (ICE) Views: Asymptomatic patients diagnosed with PHP should be referred for PTx if they fulfill the criteria for PTx. Guidance on criteria for PTx need to be disseminated to other hospital physicians and primary healthcare providers. In particular, renal impairment is a reason to proceed with PTX, rather than hold off PTx in patients with PHP.