The authors identify several factors contributing to diagnostic delay. Testing guidelines are applied inconsistently, ionised calcium is used less often than total calcium, and vitamin D deficiency can produce biochemical masking of the condition. Age-related diagnostic ambiguity, reliance on fixed calcium thresholds, and limited awareness among both patients and clinicians also contribute. Primary hyperparathyroidism is consequently often discovered incidentally, while a substantial proportion of people with biochemical evidence of the disorder remain undiagnosed. The article describes these as interacting weaknesses in the care pathway rather than the results of a prospective diagnostic trial.

Referral for surgery is presented as another major gap. The authors say arbitrary serum-calcium cut-offs and age-based differential criteria can restrict surgical referral, despite evidence that timely surgery improves outcomes across age groups. The proposed response is not a single technical change but a more consistent process: greater clinical awareness of primary hyperparathyroidism, clearer diagnostic pathways and more equitable referral for patients who may benefit from parathyroidectomy. The article also argues for recognition of the disorder as a systemic condition extending beyond its classical skeletal and renal manifestations, including neurocognitive symptoms and other potential systemic effects.

Postoperative care receives less attention than diagnosis and surgery, according to the debate. Persistent or recurrent primary hyperparathyroidism requires long-term biochemical monitoring, while skeletal recovery requires structured follow-up. The article calls for stronger evidence on disease trajectories, treatment response and long-term outcomes, as well as more consistent postoperative care. It concludes that timely recognition and equitable access to curative surgery are central to reducing disease burden and preventing avoidable morbidity, but that these goals depend on improvements across the entire care continuum.

This is a debate and synthesis of care gaps, not a clinical trial. It does not compare a particular testing strategy, referral rule or postoperative protocol in a defined patient population, and its conclusions are limited by the evidence available to the authors. Its principal reported finding is that access to a curative operation is only one part of the challenge: biochemical recognition, appropriate referral and structured follow-up remain uneven. The authors therefore frame better outcomes as dependent on coordinated improvements in diagnosis, surgical access and post-surgical monitoring.

Subject of Research: Diagnostic, surgical-access and postoperative-care gaps in primary hyperparathyroidism

Article Title: Primary hyperparathyroidism across the care continuum: gaps in diagnosis, access to surgery, and post-operative care

Article References: Menon, S., Zdraveska, N., Waghorn, A., Khan, S., & Wilmot-Roussel, H. (2026). Primary hyperparathyroidism across the care continuum: gaps in diagnosis, access to surgery, and post-operative care. BMC Medicine. https://doi.org/10.1186/s12916-026-05297-7

Image Credits: AI Generated

DOI: 10.1186/s12916-026-05297-7

Keywords: primary hyperparathyroidism, parathyroid hormone, hypercalcaemia, parathyroidectomy, diagnostic delay, healthcare access, postoperative monitoring, endocrine disease, Primary, hyperparathyroidism, across, care