A Retrospective Chart Review Characterizing Deviations in Underlying Pathology in Patients Undergoing Parathyroidectomy in South Dakota.

Abstract

Introduction: The two leading causes of primary hyperparathyroidsm are single gland adenoma and multigland hyperplasia. Classically, it has been reported that 85-90% of cases are due to a single adenoma, and the remaining 10-15% are primarily caused by multigland hyperplasia. Standard treatment is operative parathyroidectomy. An increase in cases of multigland hyperplasia in South Dakota has been observed recently, and this has not yet been analyzed.

Methods: A retrospective chart review was performed on a cohort of 440 patients. Inclusion criteria were patients receiving a diagnosis of primary hyperparathyroidism in the state of South Dakota between the years of 2017-2021. The primary outcome was postoperative diagnosis, determined by examination of documented in operative notes and pathology reports. The secondary outcome was recurrence rates, measured by rates of a second parathyroidectomy.

Results: Our data shows a statistically significant increase in cases of parathyroid hyperplasia as compared to single gland adenoma in patients undergoing parathyroidectomy in South Dakota, with 20.4% of patients receiving a postoperative diagnosis of multigland hyperplasia. Parathyroid disease recurrence rate was not significant at 2.5%.

Conclusion: Our research shows a significant deviation from previously published trends regarding underlying pathology of primary hyperparathyroidism. Proposed explanations that would warrant further studies include potential referral bias from endocrinology, difference in practices between physicians, and advancements in medical therapy allowing for a higher threshold for surgical intervention.