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Primary hyperparathyroidism: Referral patterns and outcomes of surgery
Author(s) -
Flint Richard S.,
Harman Christopher Richard,
Carter Jim,
Snyman Gerrie
Publication year - 2002
Publication title -
anz journal of surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.426
H-Index - 70
eISSN - 1445-2197
pISSN - 1445-1433
DOI - 10.1046/j.1445-2197.2002.02343.x
Subject(s) - medicine , primary hyperparathyroidism , referral , parathyroidectomy , incidence (geometry) , hyperparathyroidism , surgery , retrospective cohort study , pediatrics , parathyroid hormone , physics , family medicine , optics , calcium
Background : Parathyroidectomy has long been established as an effective treatment for primary hyperparathyroidism (HPT). Methods : A 15‐year retrospective audit was made by surgeons at North Shore Hospital, Auckland, of 33 patients with primary HPT who had parathyroidectomy. Results : There were 22 females and 11 males, ranging in age from 18 to 77 years (median 63 years). Initial diagnosis was predominantly by a general practitioner (72%), who invariably referred to a physician. Referral to surgery was made by general physicians (55%), endocrinologists (33%) and geriatricians (6%). Delay between diagnosis and referral for surgery ranged from 8 days to 10 years (median 7 months), and exceeded 2 years in 24% of patients. Twenty‐eight (85%) were symptomatic: 13 (39%) had renal symptoms, 13 (39%) had bone disease, 10 (31%) had gastrointestinal complaints, seven (21%) had psychiatric illnesses and six (18%) had fatigue. The high incidence of symptoms was matched by high biochemical values (mean serum cal‐ cium level 2.97 mmol/L), and large parathyroid glands (mean weight 2001 mg). Twenty‐nine patients (88%) had single adenomas, two (6%) had chief cell hyperplasia and two (6%) had carcinoma. Thirty‐one (94%) were cured of their primary HPT. Conclusions : Parathyroidectomy is a safe and effective treatment for primary HPT but depends upon referral from non‐surgical clinicians. A large proportion of patients have long delays before their surgery, and the group selected for surgery is referred with severe disease.