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.
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References
Craven BL, Passman C, Assimos DG (2008) Hypercalcemic states associated with nephrolithiasis. Rev Urol 10(3):218–226
Lou IBC, Clarkson S, Schneider DF, Sippel RS, Chen H (2017) How long should we follow patients after apparently “curative” parathyroidectomy? Surgery 161(1):54–61
Yeh MW et al (2013) Incidence and prevalence of primary hyperparathyroidism in a racially mixed population. J Clin Endocrinol Metab 98(3):1122–1129
Spivacow FR et al (2012) Persistence of hypercalciuria after successful surgical treatment for primary hyperparathyroidism. Int Urol Nephrol 44(3):857–863
Derrick FC (1982) Renal calculi in association with hyperparathyroidism: a changing entity. J Urol 127(2):226–226
Spivacow FR et al (2015) Biochemical diagnosis in 3040 kidney stone formers in Argentina. Urolithiasis 43(4):323–330
Sharma S et al (2017) Prevalence and predictors of primary hyperparathyroidism among patients with urolithiasis. Endocr Pract 23(11):1311–1315
Fraser WD (2009) Hyperparathyroidism. The Lancet 374(9684):145–158
Hjelmesaeth J et al (2009) Parathyroid hormone, but not vitamin D, is associated with the metabolic syndrome in morbidly obese women and men: a cross-sectional study. Cardiovasc Diabetol 8:7
Madkhali T et al (2016) Primary hyperparathyroidism. Ulus Cerrahi Derg 32(1):58–66
Silverberg SJ et al (1999) A 10-year prospective study of primary hyperparathyroidism with or without parathyroid surgery. N Engl J Med 341(17):1249–1255
Rowlands C et al (2013) Recurrent urolithiasis following parathyroidectomy for primary hyperparathyroidism. Ann R Coll Surg Engl 95(7):523–528
Mollerup CL et al (2002) Risk of renal stone events in primary hyperparathyroidism before and after parathyroid surgery: controlled retrospective follow up study. BMJ 325(7368):807
Balentine CJ et al (2017) Failure to diagnose hyperparathyroidism in 10,432 patients with hypercalcemia: opportunities for system-level intervention to increase surgical referrals and cure. Ann Surg 266(4):632–640
Blume SW, Curtis JR (2011) Medical costs of osteoporosis in the elderly medicare population. Osteoporos Int 22(6):1835–1844
Saigal CS et al (2005) Direct and indirect costs of nephrolithiasis in an employed population: opportunity for disease management? Kidney Int 68(4):1808–1814
Lindsay R (1995) The burden of osteoporosis: cost. Am J Med 98(2):9S–11S
Zanocco K, Angelos P, Sturgeon C (2006) Cost-effectiveness analysis of parathyroidectomy for asymptomatic primary hyperparathyroidism. Surgery 140(6):874–881 (discussion 881–2)
Fahy BN et al (2002) Modern parathyroid surgery: a cost-benefit analysis of localizing strategies. Arch Surg 137(8):917–922 (discussion 922–3)
Lavryk OA, Siperstein AE (2017) Use of calcium and parathyroid hormone nomogram to distinguish between atypical primary hyperparathyroidism and normal patients. World J Surg 41(1):122–128
Vaughan LE et al (2019) Predictors of symptomatic kidney stone recurrence after the first and subsequent episodes. Mayo Clin Proc 94(2):202–210
Jabbour N, Corvilain J, Fuss M, Kinnaert P, Van Geertruyden J (1991) The natural history of renal stone disease after parathyroidectomy for primary hyperparathyroidism. Surg Gynecol Obstet 172(1):25–28
CPI Inflation Calculator (2019) US Bureau of Labor Statistics. https://www.bls.gov/data/inflation_calculator.htm
Scales CD Jr et al (2012) Prevalence of kidney stones in the United States. Eur Urol 62(1):160–165
Stamatelou KK et al (2003) Time trends in reported prevalence of kidney stones in the United States: 1976–1994. Kidney Int 63(5):1817–1823
Bensalah K et al (2008) Determinants of quality of life for patients with kidney stones. J Urol 179(6):2238–2243 (discussion 2243)
Penniston KL et al (2017) Validation and reliability of the Wisconsin stone quality of life questionnaire. J Urol 197(5):1280–1288
Penniston KL, Sninsky BC, Nakada SY (2016) Preliminary evidence of decreased disease-specific health-related quality of life in asymptomatic stone patients. J Endourol 30(Suppl 1):S42–S45
Zanocco KA, Wu JX, Yeh MW (2017) Parathyroidectomy for asymptomatic primary hyperparathyroidism: a revised cost-effectiveness analysis incorporating fracture risk reduction. Surgery 161(1):16–24
Elaraj D, Sturgeon C (2014) Operative treatment of primary hyperparathyroidism: balancing cost-effectiveness with successful outcomes. Surg Clin N Am 94(3):607–623
Zanocco K, Sturgeon C (2008) How should age at diagnosis impact treatment strategy in asymptomatic primary hyperparathyroidism? A cost-effectiveness analysis. Surgery 144(2):290–298
Jang S et al (2018) Wide variation in cost of surgical care for parathyroidectomy: is there a need for standardization of practice? Surgery 163(3):638–642
Khan AA et al (2017) Primary hyperparathyroidism: review and recommendations on evaluation, diagnosis, and management. A Canadian and international consensus. Osteoporos Int 28(1):1–19
Bislev LS et al (2018) Effects of vitamin D3 Supplementation on muscle strength, mass, and physical performance in women with vitamin D Insufficiency: a randomized placebo-controlled trial. Calcif Tissue Int 103(5):483–493
Pearle MS et al (2014) Medical management of kidney stones: AUA guideline. J Urol 192(2):316–324
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Boyd, C.J., Wood, K.D., Singh, N. et al. Screening for primary hyperparathyroidism in a tertiary stone clinic, a useful endeavor. Int Urol Nephrol 52, 1651–1655 (2020). https://doi.org/10.1007/s11255-020-02476-0
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DOI: https://doi.org/10.1007/s11255-020-02476-0