The impact of minimally invasive parathyroidectomy on the way endocrinologists treat primary hyperparathyroidism.

BACKGROUND

Minimally-invasive parathyroidectomy (MIP) appears to be changing preoperative treatment and referral patterns for sporadic, nonfamilial, non-multiple endocrine neoplasia, primary hyperparathyroidism (PHPT).

METHODS

The American Association of Clinical Endocrinologists membership was surveyed by mail (n=1406 members) regarding physician practices and surgical referral patterns for PHPT.

RESULTS

Seven hundred eighty-eight respondents (56%) practiced 17.0+/-0.4 years and referred 63%+/-1% of patients with PHPT for operation. Most endocrinologists (90%) used localizing studies before surgical referral (sestamibi, ultrasound scanning, technetium/thallium scanning, magnetic resonance imaging, computed tomography). Respondents identified symptoms, calcium homeostasis, bone density, health status, age, and general anesthesia risk as the most important considerations for surgical referral. Most respondents (79%) indicated that MIP availability would increase the number of patients who were referred for operation (P<.001), although most of the respondents stated that MIP would change the extent and duration of preoperative evaluations (P<.001). Respondents in practice for fewer years were more likely to refer patients for MIP (P<.001) and minimize preoperative evaluation (P<.05). Endocrinologists who had a patient with a complication after traditional parathyroidectomy were more likely to embrace MIP (P<.05).

CONCLUSIONS

MIP availability decreases the extent and duration of preoperative evaluation while decreasing the time from diagnosis to referral. MIP also lowers the endocrinologists' surgical referral threshold for PHPT, although it emphasizes the perceived shortcomings of traditional parathyroidectomy that are held by many physicians.