Primary Hyperparathyroidism is Underdiagnosed and Suboptimally Treated in the Clinical Setting

Area of Science:

• Endocrinology
• Clinical Medicine
• Biochemistry

Background:

• Primary hyperparathyroidism (pHPT) is a common endocrine disorder.
• Guidelines exist for the management of pHPT, but adherence may vary.
• Early diagnosis and appropriate management are crucial for patient outcomes.

Purpose of the Study:

• To assess adherence to clinical guidelines for patients with laboratory findings suggestive of primary hyperparathyroidism.
• To identify potential gaps in the diagnosis and management of pHPT.

Main Methods:

• Retrospective analysis of a hospital laboratory database in Sweden.
• Identification of patients with biochemical evidence of pHPT in 2014.
• Exclusion of patients with differential diagnoses or contraindications for guideline-based investigation, confirmed by clinical assessment and further testing.

Main Results:

• 365 patients had biochemical results consistent with pHPT.
• 92 patients were referred to specialists, while 82 were not.
• Of the 82 not referred, only 9 received a diagnosis or outpatient follow-up, suggesting underdiagnosis and undertreatment.

Conclusions:

• Primary hyperparathyroidism is frequently overlooked and underdiagnosed in clinical practice.
• There is a need for local guidelines to ensure proper evaluation and follow-up for patients with mild pHPT.
• Improved management protocols are essential for patients presenting with biochemical evidence of pHPT.