Surgeon beware: Many patients referred for parathyroidectomy are misdiagnosed with primary hyperparathyroidism Journal Article


Authors: Iannuzzi, J. C.; Choi, D. X.; Farkas, R. L.; Ruan, D. T.; Peacock, J. L.; Moalem, J.
Article Title: Surgeon beware: Many patients referred for parathyroidectomy are misdiagnosed with primary hyperparathyroidism
Abstract: Purpose: We hypothesized that patients referred for the evaluation and management of primary hyperparathyroidism (pHPT) often do not have pHPT and that they may be harmed by unwarranted parathyroidectomy (PTX). Methods: We reviewed all patients who were referred to our endocrine surgery practice between 2008 and 2011 with International Classification of Diseases, Ninth Revision codes for HPT (252.00), benign or malignant parathyroid tumors (227.1, 194.1, respectively), or hypercalcemia (275.42). Patients with renal failure were excluded. Clinical parameters for investigation included age, sex, presentation, laboratories, imaging studies, and referring physician. Results: Three hundred twenty-four patients were referred for pHPT. The diagnosis was confirmed in 265 (82%), of whom 211 (80%) underwent PTX. Misdiagnoses occurred in 60 of 324 patients (19%). Of these, 54 (90%) had secondary HPT and 6 (10%) had hypercalcemia but no pHPT. Before referral, 70% of misdiagnosed patients underwent localizing studies, 57% of which suggested a positive finding. Conclusion: Considerable confusion exists regarding the differentiation of primary and secondary HPT. Surgeons should be cautioned that patients who are referred for parathyroidectomy, even those with complete laboratory and radiographic evaluations, might not have pHPT at all. © 2012 Mosby, Inc. All rights reserved.
Keywords: retrospective studies; clinical practice; diagnosis, differential; hypercalcemia; age; diagnostic errors; diagnostic error; referral and consultation; parathyroid neoplasms; gender; parathyroid tumor; patient referral; parathyroidectomy; primary hyperparathyroidism; secondary hyperparathyroidism; hyperparathyroidism, primary; hyperparathyroidism, secondary
Journal Title: Surgery
Volume: 152
Issue: 4
ISSN: 0039-6060
Publisher: Elsevier Inc.  
Date Published: 2012-10-01
Start Page: 635
End Page: 642
Language: English
DOI: 10.1016/j.surg.2012.08.018
PROVIDER: scopus
PUBMED: 23021135
DOI/URL:
Notes: --- - "Export Date: 2 November 2012" - "CODEN: SURGA" - "Source: Scopus"
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  1. Daniel Xavier Choi
    4 Choi