Elsevier

Surgery

Volume 154, Issue 6, December 2013, Pages 1232-1238
Surgery

American Association of Endocrine Surgeon
The prevalence of undiagnosed and unrecognized primary hyperparathyroidism: A population-based analysis from the electronic medical record

https://doi.org/10.1016/j.surg.2013.06.051Get rights and content

Background

The electronic medical record (EMR) of a large, tertiary referral center was examined to study the prevalence of undiagnosed and unrecognized primary hyperparathyroidism (PHPT).

Methods

The EMR was queried for outpatient serum calcium >10.5 mg/dL over a 2-year period.

Results

Of 2.7 million patients, 54,198 (2%) had hypercalcemia (>10.5 mg/dL). In a 2-year sample of 7,269 patients, 1.3% (95 patients) had a recorded diagnosis of PHPT, and 0.3% (16 patients) had parathyroidectomy. Of the remaining patients, parathyroid hormone (PTH) values were recorded in 32% (2,337 patients). Of patients with PTH measured, 71% (1,662 patients) had PHPT (PTH > 30 pg/mL). Patients with calcium of 11.1–11.5 mg/dL were most likely to have PHPT (55%). Patients with calcium >12 mg/dL were most likely to have PTH measured (52%). Of hypercalcemic patients, 67% never had PTH obtained, 28% of whom were likely to have PHPT. It is estimated that 43% of hypercalcemic patients are likely to have PHPT. The estimated prevalence of PHPT in the general population is 0.86%.

Conclusion

PHPT is a more common disorder than previously documented. It is crucial to evaluate even mild hypercalcemia, because 43% of these patients have PHPT. PHPT is underdiagnosed and undertreated.

Section snippets

Methods

The study was conducted at a large, academic, healthcare system with 9 hospitals and 13 outpatient clinics. All sites access and document patient care—including patient encounters, diagnostic studies, and laboratory data—using a shared EMR. Diagnoses are entered and updated at the discretion of physicians. We used International Classification of Disease-9 codes to extract diagnosis-related data from problem lists and encounter diagnoses entries for those codes. Current Procedural Terminology

Results

Of 6.5 million medical records searched over a 12-year period, 2.7 million patients had a primary care physician with longitudinal care in our healthcare system and were selected for the study. Of those patients, 2% (54,198 patients) had ≥2 outpatient serum calcium levels of ≥10.6 mg/dL. Because of the large number of records, the study was narrowed to a 2-year period from 2008 to 2009, yielding a study population of 7,269 patients (Fig 1). The study population was then divided into 3

Discussion

A primary objective of our study was to identify the prevalence of unrecognized or undiagnosed PHPT. In our study population of hypercalcemic patients, a large portion (43%) had undiagnosed or unrecognized PHPT with an estimated overall prevalence of 0.86% in the general population. This prevalence is >8 times greater than the commonly reported prevalence of 1 in 1,000 patients (0.1%). We feel that this is likely an underestimation of the prevalence for 2 reasons. First, patients with

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