{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,10]],"date-time":"2026-09-10T06:11:59Z","timestamp":1789020719427,"version":"build-2803163510"},"reference-count":33,"publisher":"The Endocrine Society","issue":"8","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[1998,8,1]]},"abstract":"<jats:title>abstract<\/jats:title>\n               <jats:p>A 1991 NIH Consensus Development Conference statement provided recommendations for the management of patients with asymptomatic and minimally symptomatic primary hyperparathyroidism (1\u00b0 HPT), but adherence to these guidelines has not been documented. We conducted a cross-sectional survey of North American members of the American Association of Endocrine Surgeons inquiring about surgeon and 1\u00b0 HPT patient characteristics, thresholds for surgery, and clinical outcomes. Multivariate regression was used to assess the relationship of physician characteristics to practice patterns and outcomes.<\/jats:p>\n               <jats:p>Of 190 surgeons surveyed, 147 (77%) responded; 109 provided complete responses (57%). These surgeons spend 66% of their time in patient care and perform an average of 33 (range, 1\u2013130) parathyroidectomies\/yr. More than 72% of 1\u00b0 HPT patients who underwent surgery were asymptomatic or minimally symptomatic. High volume surgeons (&amp;gt;50 cases\/yr) had significantly lower thresholds for surgery with respect to abnormalities in preoperative creatinine clearance, bone densitometry changes, and levels of intact PTH and urinary calcium compared to their low volume colleagues (1\u201315 cases\/yr). Overall reported surgical cure rates were 95.2% after primary operation and 82.7% after reoperation. Compared to high volume surgeons, low volume endocrine surgeons had significantly higher complication rates after primary operation (1.9% vs. 1.0% respectively; P &amp;lt; 0.01) and reoperation (3.8% vs. 1.5%; P &amp;lt; 0.001) as well as higher in-hospital mortality rates (1.0% vs. 0.04%; P &amp;lt; 0.05).<\/jats:p>\n               <jats:p>Endocrine surgeons operate on a large number of asymptomatic or minimally symptomatic 1\u00b0 HPT patients. Even among a group of highly experienced surgeons who typically see patients after referral from endocrinologists, clinical outcomes and criteria for surgery vary widely and appear to be associated with surgeon experience. Their criteria for surgery diverge from NIH guidelines. These results implore the endocrine community to examine the evidential basis for decisions made in the management of 1\u00b0 HPT.<\/jats:p>","DOI":"10.1210\/jcem.83.8.5006","type":"journal-article","created":{"date-parts":[[2014,1,8]],"date-time":"2014-01-08T17:03:29Z","timestamp":1389200609000},"page":"2658-2665","source":"Crossref","is-referenced-by-count":160,"title":["Thresholds for Surgery and Surgical Outcomes for Patients with Primary Hyperparathyroidism: A National Survey of Endocrine Surgeons"],"prefix":"10.1210","volume":"83","author":[{"given":"Julie Ann","family":"Sosa","sequence":"first","affiliation":[{"name":"Departments of Surgery (J.A.S., R.U., M.A.Z.), Baltimore, Maryland 21287"},{"name":"the Robert Wood Johnson Clinical Scholars Program (J.A.S., N.R.P.), The Johns Hopkins University School of Medicine, Baltimore, Maryland 21287"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Neil R.","family":"Powe","sequence":"additional","affiliation":[{"name":"Medicine (N.R.P., M.A.L.), Baltimore, Maryland 21287"},{"name":"the Robert Wood Johnson Clinical Scholars Program (J.A.S., N.R.P.), The Johns Hopkins University School of Medicine, Baltimore, Maryland 21287"},{"name":"the Departments of Epidemiology (N.R.P.), Baltimore, Maryland 21287"},{"name":"Health Policy and Management (N.R.P.), The Johns Hopkins University School of Hygiene and Public Health, Baltimore, Maryland 21287"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael A.","family":"Levine","sequence":"additional","affiliation":[{"name":"Medicine (N.R.P., M.A.L.), Baltimore, Maryland 21287"},{"name":"Pathology (M.A.L.), Baltimore, Maryland 21287"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert","family":"Udelsman","sequence":"additional","affiliation":[{"name":"Departments of Surgery (J.A.S., R.U., M.A.Z.), Baltimore, Maryland 21287"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martha A.","family":"Zeiger","sequence":"additional","affiliation":[{"name":"Departments of Surgery (J.A.S., R.U., M.A.Z.), Baltimore, Maryland 21287"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"80","reference":[{"key":"2020071614015998000_R1","doi-asserted-by":"crossref","first-page":"1317","DOI":"10.1016\/S0140-6736(80)91783-3","article-title":"Primary hyperparathyroidism: changes in the pattern of clinical presentation.","volume":"1","author":"Mundy","year":"1980","journal-title":"Lancet"},{"key":"2020071614015998000_R2","doi-asserted-by":"crossref","first-page":"473","DOI":"10.1111\/j.0954-6820.1974.tb08174.x","article-title":"Clinical findings in patients with hypercalcemia. 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