Results from a national survey on the management of primary hyperparathyroidism.

Muñoz Torres M, Jodar Gimeno E, Reyes Garcia R, Martínez Diaz Guerra G, Amado JA, Gaztambide S, Quesada Gómez JM; Calcium Study Group.

Background: Management of primary hyperparathyroidism (PHPT) continues to be challenging. At the Third International Workshop on PHPT, recent data on disease were reviewed and new clinical recommendations were developed. There are few data on the influence of new guidelines in clinical practice. Aim: We design an online survey that was sent to all Spanish hospital endocrinology services. Methods: The questionnaire included 28 questions about diagnosis and management of PHPT. 99 of 131 sites (76%), giving health coverage to 70% of Spanish population, completed the survey. Results: The reported incidence of PHPT was 9.95/100,000 person-years. 80% of patients were asymptomatic. Each centre performed a median (Q1, Q3) of 12 (6, 20) parathyroidectomies/year. The median (Q1, Q3) percentage of curative interventions (at first trial) was 90% (80, 95). The main reasons for not performing surgery were, by decreasing frequency: surgery contraindication, patient’s refusal, loss of monitoring, limited surgery experience. Localization techniques were used in 83% of cases. The main criteria for parathyroidectomy in asymptomatic patients were Ca≥2.875 mmol/l (79%), T-score≤-2.5 SD at any site (91%), age<50 years (80%) and glomerular filtration rate < 60 mL/min/1.73 m2 (82%). Minimally invasive surgery was performed in 42% of centers. Frequency of biochemistry and bone density determinations for non-surgically managed patients was in accordance with international guidelines. Conclusions: The clinical practice of Spanish endocrinologists is consistent with the recommendations of the guidelines from the Third International Workshop for the management of PHPT.

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