Failure to Diagnose Hyperparathyroidism in 10,432 Patients with Hypercalcemia

Courtney J. Balentine, Rongbing Xie, James K. Kirklin, Herbert Chen

Research output: Contribution to journalArticle

13 Citations (Scopus)

Abstract

Objective: To determine whether a significant number of patients with hyperparathyroidism remain undiagnosed and untreated. Background: Failure to diagnose primary hyperparathyroidism and refer patients to surgeons leads to impaired quality of life and increased costs. We hypothesized that many patients with hyperparathyroidism would be untreated due to not considering the diagnosis, inadequate evaluation of hypercalcemia, and under-referral to surgeons. Methods: We reviewed administrative data on 682,704 patients from a tertiary referral center between 2011 and 2015, and identified hypercalcemia (>10.5 mg/dL) in 10,432 patients. We evaluated whether hypercalcemic patients underwent measurement of parathyroid hormone (PTH), had documentation of hypercalcemia/hyperparathyroidism, or were referred to surgeons. Results: The mean age of our cohort was 54 years, with 61% females, and 56% whites. Only 3200 (31%) hypercalcemic patients had PTH levels measured, 2914 (28%) had a documented diagnosis of hypercalcemia, and 880 (8%) had a diagnosis of hyperparathyroidism in the medical record. Only 592 (22%) out of 2666 patients with classic hyperparathyroidism (abnormal calcium and PTH) were referred to surgeons. Conclusions: A significant proportion of patients with hyperparathyroidism do not undergo appropriate evaluation and surgical referral. System-level interventions which prompt further evaluation of hypercalcemia and raise physician awareness about hyperparathyroidism could improve outcomes and produce long-term cost savings.

Original languageEnglish (US)
Pages (from-to)632-640
Number of pages9
JournalAnnals of surgery
Volume266
Issue number4
DOIs
StatePublished - Oct 1 2017
Externally publishedYes

Fingerprint

Hyperparathyroidism
Hypercalcemia
Parathyroid Hormone
Referral and Consultation
Primary Hyperparathyroidism
Cost Savings
Tertiary Care Centers
Documentation
Medical Records
Quality of Life
Calcium
Physicians
Costs and Cost Analysis
Surgeons

Keywords

  • diagnosis
  • hyperparathyroidism
  • treatment

ASJC Scopus subject areas

  • Surgery

Cite this

Failure to Diagnose Hyperparathyroidism in 10,432 Patients with Hypercalcemia. / Balentine, Courtney J.; Xie, Rongbing; Kirklin, James K.; Chen, Herbert.

In: Annals of surgery, Vol. 266, No. 4, 01.10.2017, p. 632-640.

Research output: Contribution to journalArticle

Balentine, Courtney J. ; Xie, Rongbing ; Kirklin, James K. ; Chen, Herbert. / Failure to Diagnose Hyperparathyroidism in 10,432 Patients with Hypercalcemia. In: Annals of surgery. 2017 ; Vol. 266, No. 4. pp. 632-640.
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