A thorough evaluation for primary hyperparathyroidism: More than a stone's throw away

Area of Science:

• Nephrology
• Endocrinology
• Medical Diagnostics

Background:

• Primary hyperparathyroidism (PHPT) is a treatable cause of nephrolithiasis.
• PHPT is not consistently evaluated in patients presenting with kidney stones.
• This study explored parathyroid disease symptoms in relation to PHPT evaluation in nephrolithiasis patients.

Purpose of the Study:

• To assess the evaluation rate of PHPT in patients diagnosed with nephrolithiasis.
• To identify characteristics associated with PHPT evaluation and specialist referral.
• To determine the proportion of hypercalcemic nephrolithiasis patients with elevated parathyroid hormone (PTH) levels who are referred to specialists.

Main Methods:

• Identified 2264 nephrolithiasis patients diagnosed between 2017-2021.
• Measured serum calcium levels post-nephrolithiasis diagnosis.
• Assessed characteristics linked to PTH evaluation and specialist referral in hypercalcemic patients (≥ 10.2 mg/dL).

Main Results:

• 17.1% (383/2264) of nephrolithiasis patients had hypercalcemia.
• Only 27.9% (107/383) of hypercalcemic patients had PTH levels drawn.
• 63.6% of evaluated patients had elevated/non-suppressed PTH; 45.6% were referred to a specialist.

Conclusions:

• PTH evaluation is underutilized in hypercalcemic nephrolithiasis patients.
• Most evaluated patients exhibit abnormal PTH levels, yet specialist referral rates remain low.
• Improved diagnostic and referral pathways are needed for PHPT in nephrolithiasis patients.