Screening for primary hyperparathyroidism in a tertiary stone clinic, a useful endeavor
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UROLOGY - ORIGINAL PAPER
Screening for primary hyperparathyroidism in a tertiary stone clinic, a useful endeavor Carter J. Boyd1 · Kyle D. Wood2 · Nikhi Singh1 · Dustin Whitaker1 · Gerald McGwin3 · Herbert Chen4 · Dean G. Assimos2 Received: 6 January 2020 / Accepted: 15 April 2020 © Springer Nature B.V. 2020
Abstract Introduction and objectives Primary hyperparathyroidism (1HPT) is associated with the risk of developing kidney stones. Our objective was to determine the prevalence of 1HPT amongst SF evaluated at a tertiary stone clinic and determine if it is cost-effective to screen for this condition. Methods We retrospectively reviewed 742 adult SF seen by a single urologic surgeon from 2012 to 2017 all of who were screened for 1HPT with an intact serum PTH (iPTH) and calcium. The diagnosis of 1HPT was based on the presence of hypercalcemia with an inappropriately elevated iPTH or a high normal serum calcium and an inappropriately elevated iPTH. The diagnosis was confirmed by surgical neck exploration. Published cost data and stone recurrence rates were utilized to create a cost-effectiveness decision tree. Results obtained Fifty-three (7.1%) were diagnosed with 1HPT. 15 (28%) had hypercalcemia and inappropriately elevated iPTH, 38 (72%) had high normal serum calcium levels and inappropriately elevated iPTH. The potential diagnosis was ignored/missed by primary care physicians in 9 (17.0%) based on a review of prior lab results. Cost modeling was undertaken for 5, 10, 15, and 20-year intervals after screening. Based on our prevalence data, historical risks for recurrence and published cost data for stone treatments, cost savings in screening are realized at 10 years. Conclusion These results support screening for primary hyperparathyroidism in patients evaluated in a tertiary referral setting. Keywords Primary hyperparathyroidism · Cost analysis · Screening · Nephrolithiasis
Introduction Primary hyperparathyroidism (1HPT) is an endocrine disorder altering calcium homeostasis and potentially resulting in nephrolithiasis [1, 2]. With the detection and treatment of 1HPT, recurrent episodes of nephrolithiasis can be * Dean G. Assimos [email protected] 1
University of Alabama-Birmingham School of Medicine, Birmingham, AL, USA
2
Department of Urology, University of Alabama-Birmingham, Faculty Office Tower 1107, 510 20th Street South, Birmingham, AL 35249, USA
3
Department of Epidemiology, University of Alabama-Birmingham, Birmingham, AL, USA
4
Department of Surgery, University of Alabama-Birmingham, Birmingham, AL, USA
mitigated. 1HPT is found in 65.5 and 24.7 individuals per 100,000 of women and men, respectively and is much more prevalent in stone formers (2–8%) [3–7]. In addition, stone formers may have secondary hyperparathyroidism due to vitamin D deficiency, gastrointestinal malabsorption of calcium, obesity, renal insufficiency and “renal leak” hypercalciuria [8, 9]. Detection, of 1HPT and treatment with parathyroidectomy is a known way to attenuate future stone events, with a 0–1.5%
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