Diagnosis and management of primary hyperparathyroidism in Europe

QJM: An International Journal of Medicine, 05/08/2012

Langdahl BL et al. - Significant differences exist in the management of patients with asymptomatic primary hyperparathyroidism (PHPT) in countries across Europe who have accepted indications for surgery according to the NIH consensus statement. Further research will be required to explore the reasons for this and to determine if these differences affect the clinical outcome of PHPT.


  • Questionnaire-based survey.
  • Physicians in France, Germany, the UK, Italy and Spain were invited to participate in the survey which was conducted using a web-based interface and were included in the evaluation if they had treated a minimum of four patients suffering from PHPT in the past year.
  • A total of 421 physicians completed the survey.


  • The majority of respondents were endocrinologists (68%) but other specialities included rheumatologists (10.9%), internists (11.8%) and urologists (9.2%).
  • Diagnostic methods were similar across different countries and specialities but there were significant differences in the proportion of physicians who recommended parathyroidectomy in asymptomatic patients with indications for surgery according to the 2002 National Institutes of Health (NIH) consensus conference statement (χ2=26.1, P<0.001).
  • The proportion of patients referred for surgery ranged from 32% in Italy to 66% in Spain with intermediate values in Germany (64%), France (55%) and the UK (53%).
  • Conversely, pharmacological therapy was used most frequently for these patients in Italy (32%) and least frequently in Spain (14%).

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