title: Diagnosis and management of primary hyperparathyroidism in Europe.
abstract: BACKGROUND
  There is continued debate as to the optimal strategy for diagnosis and management of primary hyperparathyroidism (PHPT).
  
  
  OBJECTIVE
  To compare the strategies used for the diagnosis and management of PHPT by physicians in five European countries.
  
  
  METHODS
  Questionnaire-based survey.
  
  
  METHODS
  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.
  
  
  RESULTS
  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 (χ(2 )= 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%).
  
  
  CONCLUSIONS
  Significant differences exist in the management of patients with asymptomatic 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.
authors.affiliation: Department of Endocrinology and Internal Medicine, Aarhus University Hospital, DK-8000 Aarhus C, Denmark. bente.langdahl@aarhus.rm.dk
authors.forename: B L
authors.initials: BL
authors.lastname: Langdahl
authors.forename: S H
authors.initials: SH
authors.lastname: Ralston
mesh_terms: D001291:Attitude of Health Personnel; D004359:Drug Therapy, Combination; D004704:Endocrinology; D005060:Europe; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D049950:Hyperparathyroidism, Primary / Q000175:diagnosis / Q000188:drug therapy* / Q000601:surgery*; D007388:Internal Medicine; D007396:Internship and Residency; D008297:Male; D016105:Parathyroidectomy; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians'; D012219:Rheumatology; D011795:Surveys and Questionnaires; D014572:Urology