A Therapeutic Approach to Primary Hyperparathyroidism: A Collaborative Evaluation Between Endocrinology and Surgery

Area of Science:

• Endocrinology
• Internal Medicine
• Medical Diagnostics

Background:

• Primary hyperparathyroidism (PHPT) is characterized by excessive parathyroid hormone (PTH) production, leading to hypercalcemia.
• PHPT often presents with non-specific symptoms and can be underdiagnosed, potentially causing complications like nephrolithiasis and osteoporosis.
• Early diagnosis and treatment are crucial for managing PHPT and preventing long-term health issues.

Purpose of the Study:

• To evaluate the effectiveness of a patient-centered intervention in identifying undiagnosed primary hyperparathyroidism (PHPT) in patients with hypercalcemia.
• To assess the rate of parathyroid hormone (PTH) testing and subsequent referrals for treatment following patient notification.
• To determine the prevalence of PHPT among hypercalcemic patients identified through this outreach method.

Main Methods:

• A cohort of 546 patients with a recent hypercalcemia diagnosis was identified via EMR in Southwest Virginia.
• Patients lacking documented hypercalcemia or prior PTH testing were excluded; 150 were excluded due to lack of confirmed hypercalcemia.
• Letters were sent to eligible patients, advising discussion of PTH testing with their PCP; charts were reviewed six months later for PTH testing and referrals.

Main Results:

• Out of 396 eligible patients, 20 (5.1%) underwent PTH testing within six months.
• Of those tested, 50% had elevated PTH levels, and 45% had inappropriately normal PTH levels for their calcium concentration, suggesting PHPT.
• Eleven patients (55% of those tested) received referrals for surgical or endocrinology treatment.

Conclusions:

• Directly informing patients about hypercalcemia significantly increased PTH testing rates.
• This patient-outreach strategy successfully identified a substantial proportion of individuals with undiagnosed or suspected primary hyperparathyroidism (PHPT).
• The intervention proved clinically effective, leading to timely referrals for further evaluation and management of PHPT.