Major Gaps in Diagnosis and Treatment of Primary Hyperparathyroidism

Most cases of primary hyperparathyroidism are diagnosed when hypercalcemia is noted incidentally on chemistry panels ordered for other reasons. To shed light on how hypercalcemia and primary hyperparathyroidism are evaluated and managed, researchers in the Veterans Affairs (VA) system conducted a retrospective cohort study that involved 371,370 patients with at least two elevated serum calcium values between 2000 and 2015.

About 87,000 patients (23%) had documented serum parathyroid hormone levels, of whom 47,000 met criteria for primary hyperparathyroidism. About 6000 patients (13%) underwent parathyroidectomy; most patients who met guideline-recommended criteria for surgery (J Clin Endocrinol Metab 2014; 99:3561) did not undergo surgery. T…