Faculty Collaboration Database

Indications for operative intervention in patients with asymptomatic primary hyperparathyroidism: practice patterns of endocrine surgery. Surgery 2006 Apr;139(4):527-34

Date

04/22/2006

Pubmed ID

16627063

DOI

10.1016/j.surg.2005.09.006

Scopus ID

2-s2.0-33646041266 (requires institutional sign-in at Scopus site)   42 Citations

Abstract

BACKGROUND: Currently, many patients with primary hyperparathyroidism (PHPT) are diagnosed when they are considered to be "asymptomatic." The need for parathyroidectomy in these patients has been questioned. A consensus statement drafted after the National Institutes of Health (NIH) 2002 Workshop on Asymptomatic PHPT provided guidelines for management of such patients but has been criticized for being too conservative. The purpose of this survey was to determine the impact of these guidelines on practice patterns of endocrine surgeons.

METHODS: Members of the American Association of Endocrine Surgeons (AAES) were surveyed to determine whether previously published consensus guidelines for management of asymptomatic patients with PHPT are used to base the decision of whether to offer parathyroidectomy and to ascertain what parameters are considered indicators to proceed with operative intervention. AAES members were asked about the management of patients with asymptomatic PHPT, specialty characteristics, and demographics.

RESULTS: Of 257 AAES members, 96 (37%) responded to the survey. Although the majority of the respondents were aware of and followed the NIH consensus conference guidelines, the majority of surgeons (80%) would operate on a patient with PHPT who did not meet these criteria but had other nonspecific symptoms. Surgeons favored operative intervention when preoperative localization studies were positive, even if the criteria of the NIH guidelines were not fulfilled. Most of the responders who would operate on all patients with PHPT, regardless of objective parameters, were surgeons with a high-volume practice (>30 parathyroidectomies per year). The presence of multiple endocrine neoplasia (MEN) syndromes did not alter the decision to operate on asymptomatic patients.

CONCLUSIONS: Endocrine surgeons do not base the decision to intervene operatively in patients with PHPT solely on objective criteria. Most high-volume, experienced endocrine surgeons believe that subjective complaints warrant operative intervention.

Author List

Kouvaraki MA, Greer M, Sharma S, Beery D, Armand R, Lee JE, Evans DB, Perrier ND

Author

Douglas B. Evans MD Chair, Professor in the Surgery department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Adult
Aged
Aged, 80 and over
Female
Health Surveys
Humans
Hyperparathyroidism, Primary
Male
Middle Aged
National Institutes of Health (U.S.)
Parathyroidectomy
Practice Guidelines as Topic
Surveys and Questionnaires
United States