Use of a treatment pathway in Primary Hyperparathyroidism to ensure consistent care and appropriate use of Cinacalcet in patients unable to have operative intervention
Mr Joshua Hamby, Mrs Vanessa Hamby (Medical Students- American University of the Caribbean), Dr Steven McCann (Consultant Chemical Pathologist), Dr Richard C. Bell (Consultant Physician) Stepping Hill Hospital- Stockport NHS Foundation Trust
Objectives: To validate the use of a Primary Hyperparathyroidism treatment pathway and shared care management plan used in a secondary care setting.
Methods: We compared the biochemical laboratory data of patients presenting in 2012 and 2015 with an adjusted calcium >2.85mmol/L. These data were reviewed to identify cases of hyperparathyroidism, utilising biochemical and electronic patient record data.
Results: In a population area of around 350,000 we perform approximately 75,000 calcium tests per year. In 2012 and 2015 using an adjusted calcium threshold of >2.85 we identified 270 and 226 unique patients with significant hypercalcaemia. Of these 87 and 67 were determined to have primary hyperparathyroidism. When comparing treatment with parathyroidectomy or cinacalcet we identified a younger cohort treated surgically average age 62 and 65 (2012-2015) as opposed to average age 80 and 83 years (2012-2015) treated with cinacalcet.
Using the presented treatment pathway which biases towards use of cinacalcet if risk factors for admission are present such as falls risk or history of dementia/ delirium. We show consistent use of cinacalcet and surgery (19 cinacalcet and 19 surgery in 2012 vs 10 cinacalcet 21 surgery in 2015).
Conclusions: Although cinacalcet use in routine hyperparathyroidism is relatively new and therefore a growth treatment area. We identify a pathway of treatment that prevents its overuse as a first line treatment. When comparing parathyroidectomy vs cinacalcet treatment we found each treatment use was geared to specific age cohorts which remained consistent in 2012 and 2015.