• Courtney J Balentine, Rongbing Xie, James K Kirklin, and Herbert Chen.
• *Department of Surgery, University of Alabama at Birmingham, Birmingham, AL †Institute for Cancer Outcomes & Survivorship, University of Alabama at Birmingham, Birmingham, AL ‡Kirklin Institute for Research in Surgical Outcomes, University of Alabama at Birmingham, Birmingham, AL.
• Ann. Surg. 2017 Oct 1; 266 (4): 632-640.

ObjectiveTo determine whether a significant number of patients with hyperparathyroidism remain undiagnosed and untreated.BackgroundFailure 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.MethodsWe 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.ResultsThe 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.ConclusionsA 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.

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