Increase in presentations and procedure rates for hyperparathyroidism in Northern Sydney and New South Wales

Abstract

Objective: To examine changes in presentation of primary hyperparathyroidism and rates of parathyroidectomy in Northern Sydney (the Northern Sydney Area Heath Service) and New South Wales (NSW).

Design: Retrospective case series January 1962 - December 2001 and audit of the NSW Department of Health inpatient database (1993-1999).

Setting: University of Sydney Endocrine Surgical Unit, Royal North Shore Hospital.

Participants: 1613 patients undergoing parathyroidectomy during the study period.

Main outcome measures: Age-standardised parathyroidectomy rates and indications for surgical intervention.

Results: The age-standardised rates of parathyroidectomy for primary hyperparathyroidism in women have increased significantly in Northern Sydney from 0.14 cases per 100,000 in 1976 to 7.7 cases per 100,000 in 1996 (P < 0.001). In NSW there has been an increase in parathyroidectomy rates in women from 5.1 cases per 100,000 in 1993 to 12.3 cases per 100,000 in 1998 (P < 0.001). Osteoporosis was the most common overall indication for surgery in Northern Sydney, accounting for 27% of all cases. The proportion of cases presenting with osteoporosis increased significantly from 4% in 1962-1980 to 34% over the past decade (P < 0.001).

Conclusions: The rate of parathyroidectomy procedures has increased markedly in Northern Sydney and in NSW. The investigation of osteoporosis has led to the diagnosis of primary hyperparathyroidism in an increasing proportion of cases and has contributed to the growing surgical referral rates.