Arshad Muhammad Fahad, Balasubramanian Saba P
Sheffield Teaching Hospitals, NHS Foundation Trust, Sheffield, UK.
University of Sheffield, Sheffield, UK.
Clin Endocrinol (Oxf). 2025 Nov;103(5):757-760. doi: 10.1111/cen.70008. Epub 2025 Aug 3.
In patients with hypercalcaemia, assessment of urinary calcium excretion helps differentiate primary hyperparathyroidism (PHPT) from familial hypocalciuric hypercalcaemia (FHH). For this, 24 h calcium to creatinine clearance ratio (CCCR) is recommended, but others tests like random CCCR, 24 h urine calcium excretion (UCE), and calcium to creatinine ratio (CR) are also frequently used.
The survey objective was to evaluate current practice among UK endocrinologists and surgeons.
A web-based anonymous cross-sectional survey, consisting of eight multiple-choice questions was developed using Survey Monkey. The survey was disseminated to members of British Association of Endocrine and Thyroid Surgeons (BAETS) and Society for Endocrinology (SfE) between November 20, 2025 and December 19, 2024.
Two hundred and sixty-six responses from 210 endocrinologists and 56 surgeons were received (85% consultants). Respondents worked in both university (48.9%) and district hospitals (47.7%). The most commonly performed urine calcium test in hypercalcaemic patients was 24 h UCE (58.6%), but for PHPT versus FHH differentiation, the most preferred test was 24 h CCCR (43.6%), followed by random CCCR (24.8%), 24 h UCE (14.3%), and CR (16.5%). Of respondents who had experience with using CCCR (n = 235), most (55.6%) used a cut-off of > 0.01 to rule out FHH, while > 0.02 cut off was used by 26.7% respondents. Most clinicians (70.3%) used albumin-adjusted calcium for CCCR calculation, and 71.4% respondents considered vitamin D levels ≥ 50 nmol/L to be adequate for urinary calcium measurement.
The survey provides valuable insight into current UK practice. 24 h and random CCCR are the most commonly used tests to exclude FHH, but overall, practice varies widely.
在高钙血症患者中，评估尿钙排泄有助于区分原发性甲状旁腺功能亢进症（PHPT）和家族性低钙血症性高钙血症（FHH）。为此，推荐使用24小时钙肌酐清除率（CCCR），但随机CCCR、24小时尿钙排泄量（UCE）和钙肌酐比值（CR）等其他检测方法也经常被使用。
调查目的是评估英国内分泌科医生和外科医生的当前实践情况。
使用Survey Monkey开发了一项基于网络的匿名横断面调查，包括8个多项选择题。该调查于2025年11月20日至2024年12月19日分发给英国内分泌与甲状腺外科医生协会（BAETS）和内分泌学会（SfE）的成员。
共收到来自210名内分泌科医生和56名外科医生的266份回复（85%为顾问医生）。受访者在大学医院（48.9%）和地区医院（47.7%）工作。在高钙血症患者中，最常进行的尿钙检测是24小时UCE（58.6%），但对于PHPT与FHH的鉴别，最常用的检测方法是24小时CCCR（43.6%），其次是随机CCCR（24.8%）、24小时UCE（14.3%）和CR（16.5%）。在有使用CCCR经验的受访者（n = 235）中，大多数（55.6%）使用> 0.01的截断值来排除FHH，而26.7%的受访者使用> 0.02的截断值。大多数临床医生（70.3%）在计算CCCR时使用白蛋白校正钙，71.4%的受访者认为维生素D水平≥ 50 nmol/L足以进行尿钙测量。
该调查为英国当前的实践提供了有价值的见解。24小时和随机CCCR是排除FHH最常用的检测方法，但总体而言，实践差异很大。
