title: Results from a national survey on the management of primary hyperparathyroidism.
abstract: BACKGROUND
  Management of primary hyperparathyroidism (PHPT) continues to be challenging. At the Third International Workshop on PHPT, recent data on this disease were reviewed and new clinical recommendations were developed. There are few data on the influence of new guidelines in clinical practice.
  
  
  OBJECTIVE
  We designed an online survey that was sent to all Spanish hospital endocrinology services.
  
  
  METHODS
  The questionnaire included 28 questions about diagnosis and management of PHPT. Ninety-nine of 131 sites (76%), giving health coverage to 70% of Spanish population, completed the survey.
  
  
  RESULTS
  The reported incidence of PHPT was 9.95/100,000 person-years. Heighty percent of patients were asymptomatic. Each center performed a median (Q1, Q3) of 12 (6, 20) parathyroidectomies/year. The median (Q1, Q3) percentage of curative interventions (at first trial) was 90% (80, 95). The main reasons for not performing surgery were, by decreasing frequency: surgery contraindication, patient's refusal, loss of monitoring, limited surgery experience. Localization techniques were used in 83% of cases. The main criteria for parathyroidectomy in asymptomatic patients were Ca≥2.875 mmol/l (79%), Tscore ≤-2.5 SD at any site (91%), age <50 yr (80%) and glomerular filtration rate <60 ml/min/1.73 m 2 (82%). Minimally invasive surgery was performed in 42% of centers. Frequency of biochemistry and bone density determinations for non-surgically managed patients was in accordance with international guidelines.
  
  
  CONCLUSIONS
  The clinical practice of Spanish endocrinologists is consistent with the recommendations of the guidelines from the Third International Workshop for the management of PHPT.
authors.affiliation: Hospital Universitario San Cecilio, Granada, Spain. mmt@mamuto.es
authors.forename: M
authors.initials: M
authors.lastname: Muñoz Torres
authors.forename: E
authors.initials: E
authors.lastname: Jodar Gimeno
authors.forename: R
authors.initials: R
authors.lastname: Reyes Garcia
authors.forename: G
authors.initials: G
authors.lastname: Martínez Diaz Guerra
authors.forename: J A
authors.initials: JA
authors.lastname: Amado
authors.forename: S
authors.initials: S
authors.lastname: Gaztambide
authors.forename: J M
authors.initials: JM
authors.lastname: Quesada Gómez
mesh_terms: D017408:Guidelines as Topic; D006801:Humans; D049950:Hyperparathyroidism, Primary / Q000453:epidemiology / Q000601:surgery*; D016105:Parathyroidectomy / Q000379:methods / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D013030:Spain / Q000453:epidemiology; D018709:Statistics, Nonparametric; D011795:Surveys and Questionnaires