Expedited care for severe hypercalcaemia in primary hyperparathyroidism (PHPT) is mentioned in several guidelines and papers. Patients with a calcium ≥3mmol are more likely to require hospitalisation and ≥3.4mmol is a medical emergency. The timing of expedited care is not well defined nor the ramifications of delayed care.

Retrospective single centre cohort study (2020- 2023). Demographics presented as descriptive data. Multivariate and correlation analysis for delivery of care for hypercalcaemia ≥ 3 mmol/l vs < 3mmol/l comparing time from diagnosis to referral for surgery, referral to waitlist and waitlist to surgery. The ramifications defined by bisphosphonate administration and medical admissions.

125 patients, 95 female (76%), median age 66 (IQR 57,74) underwent parathyroidectomy with calcium ≥ 3mmol n= 21 patients and calcium >3.4 mmol/l n=9. 34% (43/125) had osteoporosis with calcium >3mmol/l predicting for worse DEXA scores (p=0.03). 90% (19/21) had single gland disease with higher rates of preoperative localisation. Calcium ≥ 3mmol/l did not have expedited referral (days 429 vs 521) (p=0.33), referral times trended to longer if calcium ≥ 3mmol/l was diagnosed during monitoring compared to primary diagnosis. Calcium ≥3mmol were not seen sooner by surgeons (p=0.19) but were operated sooner following surgical consultation (p=0.00023). Severe hypercalcaemia is associated with 79% medical admission rate and 64% use of bisphosphonates (p=0.33).

In this cohort referral for severe hypercalcaemia was not expedited, COVID 19 may have impacted this. These patients likely experience protracted symptomatic disease and healthcare shoulders the cost of increased admissions. Awareness of early surgical referral is imperative.