Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2021 Nov 24:14:11795514211059494.
doi: 10.1177/11795514211059494. eCollection 2021.

Frequency of Parathyroid Hormone Assessment in the Evaluation of Hypercalcemia. A Comparison Between Patients With and Without a History of Malignancy in a 20-year Dataset of 20,954 Patients

Michael T Sheehan  1 , Ya-Huei Li  2 , Suhail A Doi  3 , Adedayo A Onitilo  4
Affiliations

Frequency of Parathyroid Hormone Assessment in the Evaluation of Hypercalcemia. A Comparison Between Patients With and Without a History of Malignancy in a 20-year Dataset of 20,954 Patients

Michael T Sheehan et al. Clin Med Insights Endocrinol Diabetes. .

Abstract

Background: The purpose of this study was to evaluate whether a prior diagnosis of malignancy affected the assessment of parathyroid hormone (PTH) in hypercalcemic patients and whether the rate of this assessment changed over time.

Methods: A retrospective cohort study was designed that included adult patients with hypercalcemia with and without a history of malignancy between January 1, 2000 and December 31, 2019 in the Marshfield Clinic Health System (MCHS). The overall and annual rates of PTH assessment in each group was determined. In patients with a PTH assessment, duration of time and number of elevated serum calcium levels between the first documentation of hypercalcemia and the assessment of PTH were recorded, as was the degree of hypercalcemia.

Results: Approximately a quarter (23%) of the patients in each group had a PTH assessment. The rate of PTH assessment initially increased over time but later declined significantly. Although a more severe degree of hypercalcemia predicted a greater probability of PTH assessment, the rate of assessment declined with all degrees of hypercalcemia in the last 5 years. While most patients who had a PTH assessed did so within a few months of the first documentation of hypercalcemia, less than half (40%) had a delay of more than 2 years before a PTH level was drawn.

Conclusion: This lack of appropriate and timely assessment may have significant health consequences in both groups of patients. Better education of providers about the appropriate and timely assessment of PTH in the evaluation of hypercalcemia is urgently needed.

Keywords: PTH; Parathyroid hormone; hypercalcemia; malignancy.

PubMed Disclaimer

Conflict of interest statement

Declaration Of Conflicting Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.
Figure 1.
Subgroups of patients with hypercalcemia.
Figure 2.
Figure 2.
Annual PTH testing rates: (a) overall and (b) with/without history of malignancy.
Figure 3.
Figure 3.
PTH testing rates by serum calcium level (all patients).
Figure 4.
Figure 4.
PTH level by history of malignancy among hypercalcemic patients in whom a PTH level was obtained.
Figure 5.
Figure 5.
Time difference between the first elevated serum calcium and that which prompted assessment of PTH, grouped by suppressed versus non-suppressed PTH.
Figure 6.
Figure 6.
Time difference between the first elevated serum calcium and that which prompted assessment of PTH, sub-classified by the number of elevated serum calcium levels within that timeframe (both suppressed and non-suppressed PTH levels).
See this image and copyright information in PMC

References

    1. Frølich A. Prevalence of hypercalcaemia in normal and in hospital populations. Dan Med Bull. 1998;45:436-439. - PubMed
    1. Palmér M, Jakobsson S, Åkerström G, Ljunghall S. Prevalence of hypercalcaemia in a health survey: a 14-year follow-up study of serum calcium values. Eur J Clin Invest. 1988;18:39-46. - PubMed
    1. Minisola S, Pepe J, Piemonte S, Cipriani C. The diagnosis and management of hypercalcaemia. BMJ. 2015;350:h2723. - PubMed
    1. Zagzag J, Hu MI, Fisher SB, Perrier ND. Hypercalcemia and cancer: differential diagnosis and treatment. CA Cancer J Clin. 2018;68:377-386. - PubMed
    1. Carroll MF, Schade DS. A practical approach to hypercalcemia. Am Fam Physician. 2003;67:1959-1966. - PubMed