Summary
Objective Parathyroidectomy for primary hyperparathyroidism (PHPT) is curative in over 95% of cases. Although PHPT affects up to 2% of the elderly population, whose life expectancy may be a decade or more, such patients may be denied surgery because of perceived risk. This study investigates the outcomes of surgery for PHPT in the elderly.
Design and patients Consecutive patients with PHPT treated at a tertiary referral centre over 5 years.
Measurements A prospective database recorded clinical, biochemical and pathological information. Pasieka’s parathyroid symptom scores were obtained pre-operatively and post-operatively, from a recent subgroup of 70 consecutive patients. Deaths during follow-up were identified using the NHS Strategic Tracing Service. Statistical analysis was performed with spss v12.0.
Results Between November 2002 and October 2007, 224 patients (17–89 years) underwent surgery for PHPT. In the subgroup comprising patients aged >75 years there was a significantly greater proportion of women (47/56 vs. 52/81, P 75 years had a longer hospital stay (1·6 vs. 0·8 days, P = 0·003). Pasieka’s symptom scores improved significantly at 3–6 months postoperatively in all age groups. During a minimum median follow-up of 22 months, there were seven patients with persistent/recurrent disease. Median 2-year survival of those aged 60–74 and those over 75 ranged from 85–90%.
Conclusion Parathyroidectomy is safe in the elderly and is associated with a significant improvement in symptoms. As survival after operation is similar to younger patients, surgery should be considered in all elderly patients with PHPT.
Last. Greg Sadler(John Radcliffe Hospital)H-Index: 8
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Background Concordant parathyroid localization with sestamibi and ultrasound scans allows minimally invasive parathyroidectomy (MIP) to be performed in patients with non-familial primary hyperparathyroidism (PHPT).
Context: Primary hyperparathyroidism (PHPT) often presents without classical symptoms such as overt skeletal disease or nephrolithiasis. We previously reported that calciotropic indices and bone mineral density (BMD) are stable in untreated patients for up to a decade, whereas after parathyroidectomy, normalization of biochemistries and increases in BMD ensue. Objective: The objective of the study was to provide additional insights in patients with and without surgery for up to 15 yr. Design: Th...
Background Parathyroidectomy for primary hyperparathyroidism (PHPT) is expected to trigger an improvement in the quality of life. This has been demonstrated previously by using the SF-36 questionnaire, whose interpretation is difficult in routine clinical practice. As an alternative, the 13-item questionnaire developed by Pasieka et al. can be used to assess the severity of symptoms on a visual analogue from which a parathyroid assessment of symptoms score (PAS) can be calculated. The purpose of...
Context: It is unclear whether patients with asymptomatic primary hyperparathyroidism (PHPT) do better with parathyroidectomy (PTx) as compared with conservative medical management. Objective: The aim of the study was to evaluate the beneficial effect of PTx vs. conservative management in patients with mild asymptomatic PHPT. Design: We conducted a prospective, randomized study. Setting: The study took place at a referral center. Patients: We studied 50 patients who did not meet any guidelines f...
Summary Long-term follow-up is initially considered appropriate for the majority of patients with primary hyperparathyroidism (PHPT) having small increases in calcium levels ( < 2·8 mmol/l) and lacking the ‘classical’ symptoms of PHPT. The supportive reasoning is that many such patients never progress to more severe biochemical or clinical disease. There are, however, arguments in favour of early surgical treatment of such patients but adequately powered studies have not been carried out in this...
#1Kelly R. Egan(UW: University of Wisconsin-Madison)H-Index: 3
#2Joel T. Adler(UW: University of Wisconsin-Madison)H-Index: 20
Last. Herbert Chen(UW: University of Wisconsin-Madison)H-Index: 82
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Background The only cure for primary hyperparathyroidism (1°HPT) is parathyroidectomy. However, many elderly patients are not referred for surgery due to medical comorbidities and/or advanced age. The purpose of this study was to evaluate benefits against risks of parathyroidectomy in this patient population. Materials and methods From March 2001 to June 2006, 50 patients aged 80 years or older with 1°HPT underwent parathyroidectomy by a single surgeon. Clinical presentation and surgical outcome...
Context: The clinical presentation of primary hyperparathyroidism (pHPT) has changed during the last half century, and the diagnosis is now more often made by chance in patients with no specific symptoms. Objective: The present study is a randomized, controlled trial that investigates the effects of parathyroidectomy or medical observation in mild asymptomatic pHPT on morbidity and quality of life (QoL). Design/Setting/Patients: A total of 191 patients (26 men) with asymptomatic pHPT [mean age 6...
Last. Greg Sadler(John Radcliffe Hospital)H-Index: 8
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Background: Minimally invasive parathyroidectomy (MIP) is the preferred operation for patients with primary hyperparathyroidism (HPT) and positive preoperative imaging. This non-randomized case series assessed the long-term results of MIP performed without the use of intraoperative parathyroid hormone (ioPTH) monitoring. Methods: The study involved prospective collection of demographic, biochemical and operative details on a consecutive, unselected cohort of 298 patients who underwent surgery fo...
Abstract: Two randomized trials have demonstrated the safety of waiting until abdominal aortic aneurysm (AAA) diameter reaches 5.5 cm for repair in most patients. Other recent randomized trials have demonstrated lower perioperative mortality and morbidity with endovascular aneurysm repair (EVAR) compared to open surgery. Therefore, it is logical to assume that endovascular repair may change the appropriate threshold for intervention. However, endovascular repair is not as durable as open surgery...
The authors reviewed a 2-year experience with abdominal aortic aneurysm (AAA) repair to determine if patients who were excluded from endovascular aneurysm repair (EVAR) because of anatomic criteria (Group III) represented a higher risk for subsequent open aneurysm repair than either patients undergoing EVAR (Group II) or those patients who preferentially underwent open repair (Group I). Between January 2001 and December 2003, 107 patients underwent AAA repair. Open repair was recommended in pati...
Abstract Objective With the current aging of the world's population, primary hyperparathyroidism (PHPT) is increasingly detected in the elderly. Yet data on the presentation and outcome of PHPT in this group are scarce. The objective was to describe a cohort of patients aged 75 years or more with PHPT observed in our endocrine clinic. Study design A retrospective analysis of medical records in an endocrine clinic at a tertiary hospital. We evaluated 182 patients with PHPT, aged 75 years or more ...
Introduction:Hyperparathyroidism significantly decreases quality of life, yet elderly patients are underdiagnosed and undertreated even though parathyroidectomy offers definitive cure with minimal ...
Last. Rebecca S. Sippel(UW: University of Wisconsin-Madison)H-Index: 54
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Asymptomatic primary hyperparathyroidism is a very common endocrine condition, yet management of this disease process remains controversial. Primary hyperparathyroidism can lead to a myriad of symptoms which not only decreases the quality of life of patients but also increases the risk of cardiovascular disease, osteoporosis, and kidney stones. Parathyroidectomy is the only known cure for the disease. This review explores the definition of asymptomatic primary hyperparathyroidism, the burden of ...
Last. Shun-Chen Huang(Memorial Hospital of South Bend)H-Index: 1
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Summary Background Primary hyperparathyroidism (PHPT) can occur at any age. This study aimed to compare the necessity, feasibility, safety, and outcomes of parathyroidectomy in the management of minor-symptomatic or asymptomatic PHPT patients according to age (young vs. old). Methods We retrospectively reviewed the medical records of 146 consecutive patients who underwent surgery for PHPT from January 2005 to June 2016 in our institution. The patients ranged in age from 12 to 85 years. For the a...
Last. Michael J Stechman(Cardiff and Vale University Health Board)H-Index: 14
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IntroductionSince the late 1990s, a number of factors have reduced the threshold for parathyroidectomy in patients with primary hyperparathyroidism. This study examined whether this has translated into increased numbers of parathyroid operations over the last decade. MethodsA retrospective analysis was performed of the Patient Episode Database for Wales and English Hospital Episode Statistics annual data from 2000 to 2010 for parathyroidectomy admissions per 100,000 population. Statistical analy...
Last. Haggi Mazeh(HUJI: Hebrew University of Jerusalem)H-Index: 25
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Background Single adenoma is the cause of 80 % of primary hyperparathyroidism (PHPT) resulting in wide acceptance of minimally invasive parathyroidectomy (MIP). The incidence of PHPT increases with age. Little information is available regarding the prevalence of multiglandular disease (MGD) in older patients.
#1Sara E. Murray(UW: University of Wisconsin-Madison)H-Index: 8
#2Priya R. Pathak(UW: University of Wisconsin-Madison)H-Index: 3
Last. Rebecca S. Sippel(UW: University of Wisconsin-Madison)H-Index: 54
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Background The timing of symptom improvement after parathyroidectomy for primary hyperparathyroidism (PHPT) has not been well characterized. Methods This prospective study involved administering a questionnaire to patients with PHPT who underwent curative parathyroidectomy over an 11-month period. The questionnaire evaluated the frequency of 18 symptoms of PHPT on a 5-point Likert scale and was administered preoperatively and 1 week, 6 weeks, and 6 months postoperatively. Results Of 197 eligible...
Background The elderly are the fastest growing subset of the U.S. population, and suffer most from primary hyperparathyroidism. This is the first multi-institutional study to characterize 30-d outcomes in elderly patients undergoing parathyroidectomy. Materials and Methods Patients who underwent parathyroidectomy for primary hyperparathyroidism in ACS-NSQIP, 2005-8, were stratified into age groups: 45–64, 65–79, and ≥80 y. Independent patient variables included gender, race, inpatient/outpatient...