title: The prevalence of undiagnosed  and unrecognized primary  hyperparathyroidism: a  population-based analysis from the electronic medical record.
abstract: BACKGROUND
  The electronic medical record (EMR) of a large, tertiary referral center was examined to study the prevalence of undiagnosed and unrecognized primary hyperparathyroidism (PHPT).
  
  
  METHODS
  The EMR was queried for outpatient serum calcium >10.5 mg/dL over a 2-year period.
  
  
  RESULTS
  Of 2.7 million patients, 54,198 (2%) had hypercalcemia (>10.5 mg/dL). In a 2-year sample of 7,269 patients, 1.3% (95 patients) had a recorded diagnosis of PHPT, and 0.3% (16 patients) had parathyroidectomy. Of the remaining patients, parathyroid hormone (PTH) values were recorded in 32% (2,337 patients). Of patients with PTH measured, 71% (1,662 patients) had PHPT (PTH > 30 pg/mL). Patients with calcium of 11.1–11.5 mg/dL were most likely to have PHPT (55%). Patients with calcium >12 mg/dL were most likely to have PTH measured (52%). Of hypercalcemic patients, 67% never had PTH obtained, 28% of whom were likely to have PHPT. It is estimated that 43% of hypercalcemic patients are likely to have PHPT. The estimated prevalence of PHPT in the general population is 0.86%.
  
  
  CONCLUSIONS
  PHPT is a more common disorder than previously documented. It is crucial to evaluate even mild hypercalcemia, because 43% of these patients have PHPT. PHPT is underdiagnosed and undertreated.
authors.forename: Danielle M
authors.initials: DM
authors.lastname: Press
authors.forename: Allan E
authors.initials: AE
authors.lastname: Siperstein
authors.forename: Eren
authors.initials: E
authors.lastname: Berber
authors.forename: Joyce J
authors.initials: JJ
authors.lastname: Shin
authors.forename: Rosemarie
authors.initials: R
authors.lastname: Metzger
authors.forename: Rosebel
authors.initials: R
authors.lastname: Monteiro
authors.forename: Jeff
authors.initials: J
authors.lastname: Mino
authors.forename: Warren
authors.initials: W
authors.lastname: Swagel
authors.forename: Jamie C
authors.initials: JC
authors.lastname: Mitchell
mesh_terms: D002118:Calcium / Q000097:blood; D057286:Electronic Health Records; D005260:Female; D006801:Humans; D006934:Hypercalcemia / Q000097:blood / Q000453:epidemiology; D049950:Hyperparathyroidism, Primary / Q000097:blood / Q000175:diagnosis / Q000453:epidemiology*; D008297:Male; D009820:Ohio / Q000453:epidemiology; D010281:Parathyroid Hormone / Q000097:blood; D015995:Prevalence
chemical_list: C470125:PTH protein, human; D010281:Parathyroid Hormone; D002118:Calcium