Primary Hyperparathyroidism in the Elderly

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1. According to an article on mdindia.net in February, 2013, “Researchers from UCLA conducted a study utilizing a patient database from Kaiser Permanente Southern California using data from lab results which identified over 15,000 cases of chronic high calcium levels. Of those 15,000, 13,000 were diagnosed with primary hyperparathyroidism. The number of cases per 100,000 per year is as follows:

African-American 92 women / 46 men

Caucasian 81 women / 29 men

Asian 52 women / 28 men

Hispanic 49 women / 17 men

Under age 50 12 to 24 cases for both genders

Ages 50+ 80 women / 36 men

Ages 70+ 196 women / 95 men

The researchers coined it as an undertreated, underreported condition that affects mainly women and the elderly.”[3]

C. Primary hyperparathyroidism often goes undiagnosed or is misdiagnosed as other conditions and is therefore left untreated. This is due to lack of knowledge about the disease throughout the medical profession with the exception of endocrinologists, so unless you or your primary care physician have any reason to believe you should see an endocrinologist such as symptoms of diabetes for example, then you may never find out you have the disease. If they are unaware of the disease or its symptoms then why would they? So, they evaluate your symptoms, give you prescriptions for medications that should help alleviate your symptoms and send you on your way. In other cases, if you’re over a certain age and complain of bone pain, they’ll order a bone scan. If the scan indicates osteopenia or osteoporosis, they’ll give you a prescription for that and send you on your way. Therefore, the patient completely misses out on any further testing such as thyroid and parathyroid ultrasound or sestamibi scans which would pinpoint a parathyroid tumor’s location. Unfortunately, a lot of general practitioners have this “wham bam thank you m’am” way of treating their patients. They don’t dig deep enough like an endocrinologist normally would. The majority of them are so overloaded with patients, especially during cold and flu season, and just want to get everyone in and out of there in a jiffy. This is a great disadvantage for elderly people who have insurance, namely Medicare, that requires a referral to see a specialist or that refuses to cover testing unless “Medicare” deems it’s absolutely necessary. Another problem with general practitioners is that they are not informed enough about the endocrine system in general, therefore other types of endocrine diseases go undiagnosed as well. If a patient is lucky enough to be referred to an endocrinologist, the diagnosis and proper treatment will make all the difference in the world for them. The only treatment is a cure and that is surgical removal of the tumor or tumors. There are two parathyroid specialists that I have researched who specialize in minimally invasive parathyroidectomy surgery. They are Emad Kandil, MD of Tulane Medical Center in New Orleans, Louisiana and Jim Norman, MD of Norman Parathyroid Center in Tampa, Florida. Both of these surgeons get referrals from all over the world and have been teaching their expertise to hundreds of other endocrine surgeons from around the world in order to spread awareness among the medical community that no one is too old for this type of surgery. The minimally invasive outpatient procedure only requires local anesthesia and a maximum of 20 minutes on the operating table. Dr. Norman has an especially busy office. His practice of 6 surgeons performs 11 to 16 parathyroid surgeries per day. His youngest patient was 3 months old and his eldest was 105.

1. In an article on his website from 2012, parathyroid.com, Jim Norman, MD of Norman Parathyroid Center in Tampa, Florida states, “Most doctors don’t understand that the labs don’t correct normal ranges of blood calcium according to the patient’s age. Most people with a PT tumor have only slightly or modestly elevated calcium levels, so a doctor who sees this is not really alarmed and a potential tumor can go undiagnosed for years. Only an endocrinologist pays close enough attention to this. Many with PHPT will have normal serum calcium levels, but high ionized calcium as it is the high ionized calcium levels that make you feel bad. Most doctors aren’t aware that ionized calcium should be measured in parathyroid patients. Furthermore, it’s not how high the calcium levels are, it’s the duration of the high calcium levels over time that really does the damage.”[4]

2. In an article on consultant360.com in December 2013, Allen Siperstein, MD, Chairman of the Center for Endocrine Surgery at Cleveland Clinic states, “Physicians may not be aware of how common hyperparathyroidism is, or that it is the most common cause of elevated serum calcium values. There is also the misconception that hyperparathyroidism is, for the large part, an asymptomatic condition such that the diagnosis is less important to pursue or treat. The condition is three times as common in women as in men and increases with advanced aging. Normal procedure is that when there are high calcium levels detected the next step is to measure parathyroid hormone (PTH) levels. In a two year study sample of 7,260 patients, all of whom had primary care physicians in the hospital system and serum calcium values greater than 10.5 mg/dl (hypercalcemia), more than two-thirds (67%) of hypercalcemic patients had never obtained PTH value testing.”[5]

3. According to a WWLTV News Medical Watch video on youtube.com in 2010, “Dr. Emad Kandil of Tulane Medical Center in New Orleans is one of the few and top endocrine surgeons in the country who specializes in minimally invasive thyroid and parathyroid surgery through use of the DiVinci Robotic surgical device which leaves no neck scar as he makes a transaxillary (armpit) incision to perform the procedure.”[6]

4. According to an article in June 2013 on the American Association of Endocrine Surgeons webpage, endocrinediseases.org, “all patients with primary hyperparathyroidism should be considered for surgery regardless of age, 60’s, 70’s, 80’s and even 90’s, as unfortunately the elderly are missing an opportunity to be cured of PHPT with a low risk operation. These procedures are increasingly being performed on the elderly under local anesthesia.”[7]

5. In reference to an article in 2012 on parathyroid.com, Dr. Jim Norman of Norman Parathyroid Center in Tampa, Florida states, “Over 99.8% of all people who have