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Investigating the potential underdiagnosis of primary hyperparathyroidism at the University of Arkansas for Medical Sciences.

ABSTRACT: Introduction:Primary hyperparathyroidism (PHPT) is a condition in which one or more parathyroid glands secrete excess amounts of parathyroid hormone (PTH). In short, PHPT is characterized by hypercalcemia/hypercalciuria with concurrent elevated PTH levels. This condition is known to increase the risk of cardiovascular disease, osteoporosis, psychiatric disturbances, and renal complications. As of now, the disease typically runs a long course before being identified and treated. At present, surgery is the only viable treatment option for patients with this disease. Publications from other tertiary centers have identified a large-scale underdiagnosis of PHPT. The aim of this study is to determine if similar trends exist at the University of Arkansas for Medical Sciences (UAMS). Moreover, this study was seen as a first step to developing a machine learning strategy to diagnose PHPT in large clinical data sets. Methods:To evaluate for potential underdiagnosis of PHPT at UAMS, all patients from 2006 to 2018 with hypercalcemia and/or hypercalciuria (excluding those with known malignancies or other possible causes of excess serum calcium) were identified in electronic medical records. Then, it was evaluated whether these hypercalcemic/hypercalciuric patients received subsequent measurement of PTH levels necessary to confirm the diagnosis of HPT. Results:At UAMS between 2006 and 2018, 28?831 patients were identified as having hypercalcemia and/or hypercalciuria. Of these patients, only 7984 ever had subsequent PTH levels tested. Therefore, 20?847 (72.3%) of these patients never had PTH labs drawn. Conclusions:These findings may represent a significant patient population in which PHPT remains undiagnosed due to lack of follow-up. PHPT is often a silent disease with an insidious onset. At the point of diagnosis, typically the treatment is surgical removal of the offending parathyroid gland(s) (parathyroidectomy). Identification of underdiagnosis is the first step for subsequent improvement in the diagnosis of PHPT. Detection of this disease in its earlier stages may open the door for medical and lifestyle interventions, thereby decreasing long-term sequelae of the disease, such as osteoporosis, myocardial infarction, or stroke.

SUBMITTER: Quilao RJ

PROVIDER: S-EPMC7444768 | biostudies-literature | 2020 Aug

REPOSITORIES: biostudies-literature

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Investigating the potential underdiagnosis of primary hyperparathyroidism at the University of Arkansas for Medical Sciences.

Quilao Raymond J RJ Greer Melody M Stack Brendan C BC

Laryngoscope investigative otolaryngology 20200629 4

<h4>Introduction</h4>Primary hyperparathyroidism (PHPT) is a condition in which one or more parathyroid glands secrete excess amounts of parathyroid hormone (PTH). In short, PHPT is characterized by hypercalcemia/hypercalciuria with concurrent elevated PTH levels. This condition is known to increase the risk of cardiovascular disease, osteoporosis, psychiatric disturbances, and renal complications. As of now, the disease typically runs a long course before being identified and treated. At presen ...[more]

PMID: 32864451

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Project description:IntroductionPrimary hyperparathyroidism is increasingly an asymptomatic disease at diagnosis, but the recognized guidelines for management are based on evidence obtained from studies on patients with symptomatic disease, and surgery is not always indicated. Other patients are unable to undergo surgery, and thus a medical treatment is warranted. This systematic review provides an overview of the existing literature on contemporary pharmaceutical options available for the medical management of primary hyperparathyroidism.MethodsDatabases of medical literature were searched for articles including terms for primary hyperparathyroidism and each of the included drugs. Data on s-calcium, s-parathyroid hormone, bone turnover markers, bone mineral density (BMD) and hard endpoints were extracted and tabulated, and level of evidence was determined. Changes in s-calcium were estimated and a meta-regression analysis was performed.ResultsThe 1,999 articles were screened for eligibility and 54 were included in the review. Weighted mean changes calculated for each drug in s-total calcium (mean change from baseline ± SEM) were pamidronate (0.31 ± 0.034 mmol/l); alendronate (0.07 ± 0.05 mmol/l); clodronate (0.20 ± 0.040 mmol/l); mixed bisphosphonates (0.16 ± 0.049 mmol/l); and cinacalcet (0.37 ± 0.013 mmol/l). The meta-analysis revealed a significant decrease of effect on s-calcium with time for the bisphosphonates (Coef. -0.049 ± 0.023, p = 0.035), while cinacalcet proved to maintain its effect on s-calcium over time. Bisphosphonates improved BMD while cinacalcet had no effect.DiscussionThe included studies demonstrate advantages and drawbacks of the available pharmaceutical options that can prove helpful in the clinical setting. The great variation in how primary hyperparathyroidism is manifested requires that management should rely on an individual evaluation when counseling patients. Combining resorptive agents with calcimimetics could prove rewarding, but more studies are warranted.

Project description:BackgroundIn 1985 medical schools were integrated into the Ministry of Health, and the Ministry of Health and Medical Education was created in Iran. Under this infrastructure education, research and service provision are unified, and it is expected that collaboration between researchers and decision makers become easier in such an integrated context.The question here is how the researchers behavior in the biggest medical university of the country towards collaboration is, i.e. how much do decision makers participate in different stages of research? Which factors affect it?MethodologyThe samples under study were all Tehran University of Medical Sciences (TUMS) completed research projects that had gotten grants in 2004 and were over by the time this study was done. Two questionnaires were designed for this study: i) the research checklist which was filled for 301 projects, ii) the researcher's questionnaire, which was sent to principle investigators, 208 of which were collected. Multiple linear regression analysis was used for evaluating the potential factors affecting individuals 'collaboration score'.ResultsOnly 2.2 percent of TUMS' projects initiated in 2004 have had collaboration as a joint PI or co-investigator from non-academic organizations. The principle investigators mean collaboration score was 2.09, where 6 was the total score. So the collaboration score obtained was 35%. The 'type of research' had significant association with the collaboration score which is shown in the linear regression; collaboration was seen more in clinical (p = 0.007) and health system researches (p = 0.001) as compared to basic research.ConclusionThe present study shows that not many individuals collaborated as co-investigators from outside the university. This finding shows that research policy makers need to introduce interventions in this field. And assessment of barriers to collaboration and its facilitating factors should be considered in order to make it actually happen.

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Investigating the potential underdiagnosis of primary hyperparathyroidism at the University of Arkansas for Medical Sciences.

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Investigating the potential underdiagnosis of primary hyperparathyroidism at the University of Arkansas for Medical Sciences.

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