World Journal of Endocrine Surgery

Register      Login

VOLUME 13 , ISSUE 3 ( September-December, 2021 ) > List of Articles

Original Article

A Retrospective Study of Incidental Primary Hyperparathyroidism in an Acute Hospital Population and Review of the Literature

Tzu-Yi Arron Chuang, Zhen Qi Lu, Justin Gundara

Keywords : Hypercalcemia, Hyperparathyroidism, Parathyroidectomy

Citation Information : Chuang TA, Lu ZQ, Gundara J. A Retrospective Study of Incidental Primary Hyperparathyroidism in an Acute Hospital Population and Review of the Literature. World J Endoc Surg 2021; 13 (3):86-91.

DOI: 10.5005/jp-journals-10002-1415

License: CC BY-NC 4.0

Published Online: 19-05-2022

Copyright Statement:  Copyright © 2021; The Author(s).


Abstract

Background: Hypercalcemia and associated primary hyperparathyroidism (pHPT) are relatively common but are likely to be under-recognized and undertreated. This study aimed to assess the prevalence of incidental hypercalcemia, investigation, and follow-up with definitive care for an acute surgical Australian metropolitan population. This was complemented by a systematic review of the literature. Materials and methods: A retrospective cohort study was conducted in a metropolitan, 172-bed general hospital within the Metro South Health service district of South-East Queensland, Australia. The electronic medical records of all acute general surgical admissions over a 6-month period (February–July 2019 inclusive) were reviewed and analyzed. This was supplemented by a systematic literature review of incidental hypercalcemia and hyperparathyroidism. Results: Of 486, eligible patients requiring acute surgical admission, two were identified to possess incidental hypercalcemia, equating to an incidence of 0.41%. Within this context, the systematic review revealed a reported hypercalcemia prevalence of between 0.1 and 3.3% and a pHPT prevalence of between 1.3 and 3.5%. The incidence of new pHPT was between 6 and 50 per 1,00,000. Discussion: This study is the first to investigate the incidence of incidental hypercalcemia and related hyperparathyroidism in an acute general surgical admission setting. Whilst the outcomes of this study have not shown expectedly high rates of hypercalcemia and hyperparathyroidism, this provides a platform for future clinical education, awareness, local protocol development, and improved patient care. Clinical significance: The first study to investigate the incidence of incidental hypercalcemia and hyperparathyroidism in an acute general surgical admission setting. Lower than expected rates of hypercalcemia and hyperparathyroidism (2 out of 486 eligible patients) based on literature review which sets the platform for future research directions.


PDF Share
  1. Abood A, Vestergaard P. Increasing incidence of primary hyperparathyroidism in Denmark. Dan Med J 2013;60(2):A4567.
  2. Balentine CJ, Xie R, Kirklin JK, et al. Failure to diagnose hyperparathyroidism in 10,432 patients with hypercalcemia opportunities for system-level intervention to increase surgical referrals and cure. Ann Surg 2017;266(4):632–640. DOI: 10.1097/SLA.0000000000002370
  3. Enell J, Bayadsi H, Lundgren E, et al. Primary hyperparathyroidism is underdiagnosed and suboptimally treated in the clinical setting. World J Surg 2018;42(9):2825–2834. DOI: 10.1007/s00268-018-4574-1
  4. Press DM, Siperstein AE, Berber E, et al. The prevalence of undiagnosed and unrecognized primary hyperparathyroidism: a population-based analysis from the electronic medical record. Surgery 2013;154(6):1232–1238. DOI: 10.1016/j.surg.2013.06.051
  5. Asban A, Dombrowsky A, Mallick R, et al. Failure to diagnose and treat hyperparathyroidism among patients with hypercalcemia: opportunities for intervention at the patient and physician level to increase surgical referral. Oncologist 2019;24(9):e828–e834. DOI: 10.1634/theoncologist.2018-0424
  6. Dombrowsky A, Borg B, Xie R, et al. Why is hyperparathyroidism underdiagnosed and undertreated in older adults? Clin Med Insights Endocrinol Diabetes 2018;11. DOI: 10.1177/1179551418815916
  7. Arrangoiz R, Cordera F, Caba D, et al. The appropriate diagnosis of primary hyperparathyroidism. Int J Med Rev Case Rep 2019;3(11): 730–741. DOI: 10.5455/IJMRCR
  8. Stephen AE, Mannstadt M, Hodin RA. Indications for surgical management of hyperparathyroidism: a review. JAMA Surg 2017;152(9):878–882. DOI: 10.1001/jamasurg.2017.1721
  9. Fisher SB, Perrier ND. Incidental hypercalcemia and the parathyroid. J Am Coll Surg 2018;226(6):1181–1189. DOI: 10.1016/j.jamcollsurg.2018.03.022
  10. Silverberg SJ, Lewiecki EM, Mosekilde L, et al. Presentation of asymptomatic primary hyperparathyroidism: proceedings of the third international workshop. J Clin Endocrinol Metab 2009;94(2):351–365. DOI: 10.1210/jc.2008-1760
  11. Barczyński M, Bränström R, Dionigi G, et al. Sporadic multiple parathyroid gland disease—a consensus report of the European society of endocrine surgeons (ESES). Langenbecks Arch Surg 2015;400(8):887–905. DOI: 10.1007/s00423-015-1348-1
  12. Collier A, Portelli M, Ghosh S, et al. Primary hyperparathyroidism: Increasing prevalence, social deprivation, and surgery. Endocr Res 2017;42(1):31–35. DOI: 10.3109/07435800.2016.1169545
  13. Wilhelm SM, Wang TS, Ruan DT, et al. The American association of endocrine surgeons guidelines for definitive management of primary hyperparathyroidism. JAMA Surg 2016;151(10):959–968. DOI: 10.1001/jamasurg.2016.2310
  14. Moher D, Liberati A, Tetzlaff J, et al. Reprint–preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Phys Ther 2009;89(9):873–880. DOI: 10.1093/ptj/89.9.873
  15. Yeh MW, Ituarte PHG, Zhou HC, et al. Incidence and prevalence of primary hyperparathyroidism in a racially mixed population. J Clin Endocrinol Metab 2013;98(3):1122–1129. DOI: 10.1210/jc.2012-4022
  16. Fraser WD. Hyperparathyroidism. Lancet 2009;374(9684):145–158. DOI: 10.1016/S0140-6736(09)60507-9
  17. Lindner G, Felber R, Schwarz C, et al. Hypercalcemia in the ED: prevalence, etiology, and outcome. Am J Emerg Med 2013;31(4): 657–660. DOI: 10.1016/j.ajem.2012.11.010
  18. Royer AM, Maclellan RA, Stanley JD, et al. Hypercalcemia in the emergency department: a missed opportunity. Am Surg 2014;80(8):732–735. DOI: 10.1177/000313481408000819
  19. Chen H. Parathyroid disease: often forgotten and undertreated. Am Surg 2020;86(7):730–733. DOI: 10.1177/0003134820940731
  20. Yu N, Donnan PT, Leese GP. A record linkage study of outcomes in patients with mild primary hyperparathyroidism: the parathyroid epidemiology and audit research study (PEARS). Clin Endocrinol (Oxf) 2011;75(2):169–176. DOI: 10.1111/j.1365-2265.2010.03958.x
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.