Diagnosis and management of primary hyperparathyroidism in Europe

B L Langdahl, S H Ralston, B L Langdahl, S H Ralston

Abstract

Background: There is continued debate as to the optimal strategy for diagnosis and management of primary hyperparathyroidism (PHPT).

Aim: To compare the strategies used for the diagnosis and management of PHPT by physicians in five European countries.

Design: Questionnaire-based survey.

Methods: Physicians in France, Germany, the UK, Italy and Spain were invited to participate in the survey which was conducted using a web-based interface and were included in the evaluation if they had treated a minimum of four patients suffering from PHPT in the past year.

Results: A total of 421 physicians completed the survey. The majority of respondents were endocrinologists (68%) but other specialities included rheumatologists (10.9%), internists (11.8%) and urologists (9.2%). Diagnostic methods were similar across different countries and specialities but there were significant differences in the proportion of physicians who recommended parathyroidectomy in asymptomatic patients with indications for surgery according to the 2002 National Institutes of Health (NIH) consensus conference statement (χ(2 )= 26.1, P < 0.001). The proportion of patients referred for surgery ranged from 32% in Italy to 66% in Spain with intermediate values in Germany (64%), France (55%) and the UK (53%). Conversely, pharmacological therapy was used most frequently for these patients in Italy (32%) and least frequently in Spain (14%).

Conclusion: Significant differences exist in the management of patients with asymptomatic PHPT in countries across Europe who have accepted indications for surgery according to the NIH consensus statement. Further research will be required to explore the reasons for this and to determine if these differences affect the clinical outcome of PHPT.

Figures

Figure 1.
Figure 1.
Preferred management strategies for symptomatic PHPT. Values (%) are respondents’ answers to the multi-choice Question 11 ‘When a PHPT patient is symptomatic do you … ?’ Respondents chose a single answer from a multi-choice list.
Figure 2.
Figure 2.
Preferred management strategies for asymptomatic PHPT. Values (%) are respondents’ answers to the multi-choice Question 12 ‘When a PHPT patient is asymptomatic do you … ?’ aRecommendation based on 2002 NIH Consensus Development Guidelines.
Figure 3.
Figure 3.
Patients receiving preferred combination pharmacological therapies for the treatment of PHPT. Values are estimate percentages of the number of patients with PHPT receiving combination therapy given by those physicians ranking combination therapy from 1–3 (1, most suitable; 6, least suitable).

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