Highlights
- •Primary hyperparathyroidism (PHPT) is increasingly detected in the elderly.
- •In this study, patients aged over 75 years with primary hyperparathyroidism were followed up for more than a decade.
- •Many of the patients in our cohort had a formal indication for surgery.
- •For 141 non-operated patients, serum and urinary levels of calcium decreased and vitamin D levels increased at last visit compared with levels at diagnosis.
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 at their last follow-up,
all diagnosed at age 65 or more. Laboratory data were compared at diagnosis and last
follow-up.
Results
Mean age at diagnosis was 73 ± 4 years, last follow-up was at 83 ± 4 years, and mean
follow-up was 11.3 ± 5.5 years. Osteoporosis, fractures, and nephrolithiasis were
diagnosed in 114(63 %), 84(46 %), and 43(24 %) patients, respectively. Overall, 150
patients had an indication for surgery; of them, the 29 who underwent parathyroidectomy
were younger than the non-operated patients and had higher rates of hypercalciuria.
During the follow-up of the 141 patients who did not undergo operation, serum and
urinary calcium levels significantly had decreased, and vitamin D level had increased
at last visit (10.4 ± 0.5 mg/dl, 161 ± 70 mg/24 h, 69 ± 17 nmol/l, p < 0.01 respectively)
compared with levels at diagnosis (10.6 ± 0.2 mg/dl, 223 ± 95 mg/24 h, 53 ± 15 nmol/l,
respectively, p = 0.001). Overall, 38 of the 182 patients (20 %) died during follow-up;
these patients were significantly older at diagnosis (76 ± 5 vs. 72 ± 4 years) but
there were no differences in laboratory variables.
Conclusions
While most patients had a formal indication for surgery, few underwent parathyroidectomy.
Serum and urinary calcium significantly decreased during follow-up in patients who
did not undergo surgery. Our data are reassuring and support at least the consideration
of conservative treatment for these patients.
Keywords
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Article info
Publication history
Published online: February 29, 2020
Accepted:
February 28,
2020
Received in revised form:
February 19,
2020
Received:
November 14,
2019
Identification
Copyright
© 2020 Published by Elsevier B.V.
