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Hyperparathyroidism in patients over 75: Clinical characteristics and outcome. Is conservative treatment a safe alternative?
- Source :
- Maturitas. 135:47-52
- Publication Year :
- 2020
- Publisher :
- Elsevier BV, 2020.
-
Abstract
- 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.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.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, p0.01 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.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.
- Subjects :
- Male
Parathyroidectomy
Pediatrics
medicine.medical_specialty
medicine.medical_treatment
Osteoporosis
Population
Conservative Treatment
Nephrolithiasis
General Biochemistry, Genetics and Molecular Biology
Fractures, Bone
03 medical and health sciences
0302 clinical medicine
medicine
Humans
Hypercalciuria
030212 general & internal medicine
Vitamin D
education
Aged
Retrospective Studies
Aged, 80 and over
Hyperparathyroidism
education.field_of_study
030219 obstetrics & reproductive medicine
business.industry
Obstetrics and Gynecology
Hyperparathyroidism, Primary
medicine.disease
Urinary calcium
Cohort
Calcium
Female
business
Primary hyperparathyroidism
Subjects
Details
- ISSN :
- 03785122
- Volume :
- 135
- Database :
- OpenAIRE
- Journal :
- Maturitas
- Accession number :
- edsair.doi.dedup.....c378b3a470b348d859ad065359480754