Parathyroidectomy in the west Midlands

A retrospective audit was made of 101 patients undergoing parathyroidectomy, performed by 20 general surgeons in the West Midlands region during 1992. The mean number of cases per surgeon was five; nine surgeons performed fewer than three parathyroidectomies. Some 57 patients had primary hyperparathyroidism. Only seven were diagnosed by general practitioners and referral was invariably to a non-endocrine physician. Delay between diagnosis and surgical referral exceeded 2 years in 12 patients. Four patients (7 per cent) with primary hyperparathyroidism remained hypercalcaemic after first exploration; all were operated on by surgeons who performed fewer than four parathyroidectomies per year. Minor complications occurred in 32 per cent of patients. All 44 patients with renal hyperparathyroidism were treated in specialist units where diagnosis and treatment were expeditious; parathyroidectomy was successful in 41. Hyperparathyroidism should be managed in specialized units and by surgeons who perform parathyroidectomy frequently. A heightened awareness of primary hyperparathyroidism is required at primary care level.