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. 2023 Nov 23;15(11):e49290.
doi: 10.7759/cureus.49290. eCollection 2023 Nov.

Underdiagnosis of Hyperparathyroidism in Patients With Nephrolithiasis in a Community Setting

Cameron D Moore  1 , Bassil Azam  2 , Helena Do  1 , Kayla Williamson  3 , Amber H Chambers  4 , Muhammad Owais Abdul A Ghani  1
Affiliations

Underdiagnosis of Hyperparathyroidism in Patients With Nephrolithiasis in a Community Setting

Cameron D Moore et al. Cureus. .

Abstract

Objective Untreated primary hyperparathyroidism (PHPT) has wide-ranging multisystemic effects. Recent studies based in the US have shown a less than 25% screening rate for PHPT. Our study aims to detect whether similar deficiencies exist in our community healthcare system while quantifying the prevalence of PHPT underdiagnosis and inadequate surgical referrals. Study design This retrospective quantitative study enrolled patients aged ≥18 years with imaged-confirmed nephrolithiasis at our healthcare facilities from 2017 to the present (n=2021). Patients with documented calcium levels and kidney/ureter stones were included. Descriptive and univariate analyses were performed. Results A total of 2021 subjects met the criteria to be enrolled in the study. 26.6% (n=537) of patients with nephrolithiasis had elevated calcium levels on record. 13.6% (n=73) of hypercalcemic patients were screened for PHPT with an intact parathyroid hormone (PTH). A majority (63%, n=46) of patients with intact PTH had PHPT defined as PTH levels >55 pg/mL. Ultimately, only 19.6% (n=9) of patients with PHPT were referred for surgical intervention, and there was no significant difference in referral rate between patients with PHPT and those without (p=0.913). Conclusions PHPT is underdiagnosed in our community, leading to a significantly low rate of surgical referral and delay in management. Implementation of hospital protocols to aid in improving diagnosis and interventions could improve outcomes for PHPT patients.

Keywords: burden of disease; hypercalcemia; hyperparathyroidism; nephrolithiasis; parathyroid hormone.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. Patient selection and distribution.
PTH: parathyroid hormone; GS: general surgery.
See this image and copyright information in PMC

References

    1. Bilezikian JP, Marcus R, Levine MA, Marcocci C, Silverberg SJ, Potts JT. London: Academic Press; 2014. The Parathyroids: Basic and Clinical Concepts.
    1. Primary hyperparathyroidism and nephrolithiasis. Vestergaard P. Ann Endocrinol (Paris) 2015;76:116–119. - PubMed
    1. Nephrolithiasis and bone involvement in primary hyperparathyroidism. Silverberg SJ, Shane E, Jacobs TP, et al. Am J Med. 1990;89:327–334. - PubMed
    1. Primary hyperparathyroidism. Bilezikian JP. J Clin Endocrinol Metab. 2018;103:3993–4004. - PMC - PubMed
    1. Prevalence of kidney stones and vertebral fractures in primary hyperparathyroidism using imaging technology. Cipriani C, Biamonte F, Costa AG, et al. J Clin Endocrinol Metab. 2015;100:1309–1315. - PMC - PubMed

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