Testing for Primary Hyperparathyroidism in 17,491 Patients With Hypercalcemia.

Area of Science:

• Endocrinology
• Internal Medicine
• Health Services Research

Background:

• Primary hyperparathyroidism (PHPT) is often underdiagnosed, despite its association with significant adverse health effects.
• Historically, parathyroid hormone (PTH) testing has not been consistently applied to all hypercalcemic patients, with reasons for this gap remaining unclear.

Purpose of the Study:

• To determine the rate of PTH testing among hypercalcemic individuals within a large academic health system.
• To identify patient characteristics associated with or against PTH testing for PHPT.
• To inform strategies aimed at improving PHPT diagnosis rates.

Main Methods:

• Retrospective analysis of adult patients with at least one elevated serum calcium level between 2018 and 2022.
• Patients were categorized into 'screened' (PTH tested) or 'unscreened' groups.
• Comparison of demographic and clinical characteristics between the screened and unscreened cohorts.

Main Results:

• Out of 17,491 hypercalcemic patients, only 34.9% (6096) received PTH testing.
• Factors significantly increasing odds of testing included multiple elevated calcium results, chronic kidney disease, very high calcium levels (>12.0 mg/dL), and osteoporosis.
• Factors associated with lower testing odds included younger age (<35 years), older age (≥85 years), and depression.

Conclusions:

• The study reveals a low PTH testing rate (35%) among hypercalcemic patients.
• While comorbidities generally increased testing likelihood, patients with depression showed a 16% decreased likelihood of being tested for PHPT.