Document Detail

Surgeon beware: many patients referred for parathyroidectomy are misdiagnosed with primary hyperparathyroidism.
MedLine Citation:
PMID:  23021135     Owner:  NLM     Status:  MEDLINE    
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.
James C Iannuzzi; Daniel X Choi; Rachel L Farkas; Daniel T Ruan; James L Peacock; Jacob Moalem
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Surgery     Volume:  152     ISSN:  1532-7361     ISO Abbreviation:  Surgery     Publication Date:  2012 Oct 
Date Detail:
Created Date:  2012-10-01     Completed Date:  2012-12-13     Revised Date:  2013-08-22    
Medline Journal Info:
Nlm Unique ID:  0417347     Medline TA:  Surgery     Country:  United States    
Other Details:
Languages:  eng     Pagination:  635-40; discussion 640-2     Citation Subset:  AIM; IM    
Copyright Information:
Copyright © 2012 Mosby, Inc. All rights reserved.
Department of Surgery, University of Rochester, Rochester, NY 14642, USA.
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MeSH Terms
Diagnosis, Differential
Diagnostic Errors*
Hypercalcemia / diagnosis,  surgery
Hyperparathyroidism, Primary / diagnosis*,  surgery*
Hyperparathyroidism, Secondary / diagnosis,  surgery
Parathyroid Neoplasms / diagnosis,  surgery
Referral and Consultation
Retrospective Studies
Comment In:
Surgery. 2013 Jul;154(1):134-5   [PMID:  23809491 ]
Surgery. 2013 Jul;154(1):134   [PMID:  23453326 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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