Audit of local management of hyperparathyroidism and evaluation of vitamin D deficiency in PHPT

Dr Tannaz Vakilgilani and Dr Peter Winocour

Welwyn Garden City.


Introduction: Primary hyperparathyroidism (PHPT) is a relatively frequent problem presenting with hypercalaemia detected on a routine blood test. All PHPT patients should have a urine calcium concentration, DEXA scan and vitamin D level checked at the time of diagnosis. Vitamin D supplementation aims to achieve a vitamin D level over 50 nmol/lit which may be associated with positive outcomes such as a lower serum parathormone (PTH), calcium and alkaline phosphatase concentration and decreased bone turnover.  

Aim: We conducted a retrospective observational study into the diagnosis and management of primary hyperparathyroidism and the evaluation and replacement of vitamin D deficiency in this group to determine compliance with national guidelines. 

Method: PHPT patients were identified from the pathology database as those with hypercalcemia and a normal or inappropriately high PTH with no concomitant renal impairment. 67 patients were identified. Further data was collected from patient records, biochemistry results and radiology reports. 



Urinary calcium creatinine at diagnosis 

Vitamin D level checked at diagnosis / Vitamin D level checked at any time 


DEXA scan 


Radiological imaging (ultrasound scan/ Sestamibi Scan) Prior to surgery 



n= 41 (71%) 

n=4/ /54( 60%/ 82%) 


n=50 (86%) 


n=16 (100%) 




71% deficient 

(33% achieved repletion of which 58% maintained vitamin D  levels) 

Significant improvement in PTH and no serum [calcium] change with vit D treatment compared to no vit D treatment 

66% hip osteopenia or osteoporosis (mean hip T score -1.37) 

68% spine osteopenia or osteoporosis (mean spine T score -1.55) 



Conclusion: The diagnostic work-up for PHPT needs to be improved to achieve full compliance with national guidelines. This could be achieved with the use of an out-patient proforma and requesting a panel of bloods (eg “PHPT Panel”) rather than individual tests. Vitamin D supplementation is beneficial for the treatment of PHPT.