Q017

Audit of local management of hyperparathyroidism and evaluation of vitamin D deficiency in PHPT

Dr Tannaz Vakilgilani and Dr Peter Winocour

Welwyn Garden City.

 

Introduction: Primary hyperparathyroidism (PHPT) is a relatively frequent problem presenting with hypercalaemia detected on a routine blood test. All PHPT patients should have a urine calcium concentration, DEXA scan and vitamin D level checked at the time of diagnosis. Vitamin D supplementation aims to achieve a vitamin D level over 50 nmol/lit which may be associated with positive outcomes such as a lower serum parathormone (PTH), calcium and alkaline phosphatase concentration and decreased bone turnover.  

Aim: We conducted a retrospective observational study into the diagnosis and management of primary hyperparathyroidism and the evaluation and replacement of vitamin D deficiency in this group to determine compliance with national guidelines. 

Method: PHPT patients were identified from the pathology database as those with hypercalcemia and a normal or inappropriately high PTH with no concomitant renal impairment. 67 patients were identified. Further data was collected from patient records, biochemistry results and radiology reports. 

Results: 

 

Urinary calcium creatinine at diagnosis 

Vitamin D level checked at diagnosis / Vitamin D level checked at any time 

 

DEXA scan 

 

Radiological imaging (ultrasound scan/ Sestamibi Scan) Prior to surgery 

 

Performed? 

n= 41 (71%) 

n=4/ /54( 60%/ 82%) 

 

n=50 (86%) 

 

n=16 (100%) 

 

Results 

 

71% deficient 

(33% achieved repletion of which 58% maintained vitamin D  levels) 

Significant improvement in PTH and no serum [calcium] change with vit D treatment compared to no vit D treatment 

66% hip osteopenia or osteoporosis (mean hip T score -1.37) 

68% spine osteopenia or osteoporosis (mean spine T score -1.55) 

 

 

Conclusion: The diagnostic work-up for PHPT needs to be improved to achieve full compliance with national guidelines. This could be achieved with the use of an out-patient proforma and requesting a panel of bloods (eg “PHPT Panel”) rather than individual tests. Vitamin D supplementation is beneficial for the treatment of PHPT.