Parathyroidectomy for Primary Hyperparathyroidism in Octogenarians and Nonagenarians: A Risk–Benefit Analysis

Egan, Kelly R.; Adler, Joel T.; Olson, Judith Reitman; Chen, Herbert

doi:10.1016/j.jss.2007.01.027

Cited by 57 publications

(42 citation statements)

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“…Power calculations were not provided in the above studies; therefore, lack of a statistically significant difference between age groups might have been attributable to insufficient power to detect such differences. The outcomes of 50 patients aged 80 y and older undergoing parathyroidectomy by a single surgeon were reported by Egan and colleagues [21]; the authors concluded that the benefits of surgery in patients aged 80 y and older outweighed the risks (complication rate of 4%).…”

Section: Discussionmentioning

confidence: 94%

Parathyroidectomy in the Elderly: Analysis of 7313 Patients

Thomas

Roman

Sosa

2011

Journal of Surgical Research

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Section: Discussionmentioning

confidence: 94%

Parathyroidectomy in the Elderly: Analysis of 7313 Patients

Thomas

Roman

Sosa

2011

Journal of Surgical Research

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“…This data confirms our previous report that symptoms improve significantly at 6 months postoperatively in all age groups [19]. Similarly, in a study of 50 patients, octogenarians and nonagenarians, greater than 60% reported improved physical functioning, social a The ratio between postoperative and preoperative PPSS was used to identify patients who improved (i.e., postoperative score reduced by more than 10%, 25%, or 50%, respectively), had no change (i.e., postoperative score less than preoperative but less than 10%, 25%, or 50%), or who worsened (i.e., with postoperative scores higher than preoperative scores) functioning, and/or mental health and reduction of bodily pain after parathyroidectomy [20]. Marked improvements in depressive mood, psychomotor inhibition, anxiety, and somatic symptoms after PTX were also reported in a small study of octogenarians assessed using Hamilton Rating Scale for Depression [21].…”

Section: Discussionmentioning

confidence: 99%

Persistent symptomatic improvement in the majority of patients undergoing parathyroidectomy for primary hyperparathyroidism

Gopinath

Sadler

Mihai

2010

Langenbecks Arch Surg

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“…In the elderly, surgery has a high cure rate, low morbidity, no mortality, and a short length of hospital stay. Surgery was found to be optimal relative to medical management when life expectancy reached 5 years for outpatients and 6.5 years for inpatients [84,85]. Finally, in pregnant women, a cervical ultrasound can be used for preoperative localization, and surgery is the treatment of choice during the second trimester [30].…”

Section: Special Conditions In Parathyroid Surgerymentioning

confidence: 99%

Current Concepts in the Presentation, Diagnosis and Management of Primary Hyperparathyroidism

Alhefdhi¹

2015

Surgery

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Review ArticleOpen Access IntroductionPrimary hyperparathyroidism (PHPT) is defined by an abnormal increase in the intrinsic activity of the parathyroid gland(s) that result in elevated parathyroid hormone (PTH) levels [1,2]. It is one of the most common endocrine disorders and is the most common cause of hypercalcemia. PHPT is one of the most common endocrine disorders and is the most common cause of hypercalcemia, which increases morbidity and mortality that result from cardiovascular, renal, and musculoskeletal pathologies. PHPT affects 1 in 500 females and 1 in 2,000 males aged >40 years, with a peak incidence in post-menopausal women. In the US, Europe, and Australia, the reported estimated incidence rates range from 25 to 30 per 100,000 person years, and the prevalence range from 1 to 21 per 1,000 individuals [1][2][3][4].PHPT has been a recognizable disease since the 1920s in both Europe and the US [5]. The first parathyroidectomy was performed in 1925 by Felix Mandl in Vienna, Austria; since then, the diagnosis and management of PHPT have progressed [5]. The purpose of this article is to review the current trends of PPT presentation, work-up, and management. Anatomy and PhysiologyHumans typically have four parathyroid glands located at the posterior capsule of the thyroid gland; in up to 15% of individuals have more than four and up to 3% have three identifiable glands [6]. The superior parathyroid glands arise from the IV pharyngeal pouch and migrate to the cephalad thyroid gland; they are usually located at the cricothyroid junction, 1 cm from the recurrent laryngeal nerve and the inferior thyroid artery. Inferior parathyroid glands arise from the III pharyngeal pouch and migrate caudally with the thymus; they are usually located on the posterolateral aspect of the inferior pole of the thyroid gland. Normal parathyroid glands are yellow or brown in color, oval in shape, 3-7 mm in length, and 30-40 mg in weight [7,8].A parathyroid gland consists of chief cells, oxyphilic cells, a thin fibrous capsule, and a network of adipose tissue, blood vessels, and glandular parenchyma [8]. Chief cells secrete PTH, which consists of 84 amino acid polypeptides. The normal serum PTH level range is 15-72 pg/mL, with a half-life of 2-4 min. Seventy percent of PTH metabolism occurs in the liver and 30% in the kidneys [9][10][11]. PTH is regulated by serum calcium, phosphorus, and vitamin D metabolites. The total normal calcium level should be 8.8-10.2 mg/dL (ionized calcium 2.2-2.6 mmol/L) to ensure optimum physiological functions [9][10][11]. PTH levels are inversely proportional to serum calcium levels, as high serum calcium levels decrease PTH release [5][6][7] and low serum calcium levels increase PTH secretion. This relationship enhances renal tubular calcium reabsorption, urinary phosphate excretion, osteoclastmediated bone resorption, and the conversion of 25-hydroxyvitamin D3 into 1,25-hydroxyvitamin D3, which increases calcium absorption from the bowel [9-11]. EtiologyNinety-five percent of PHPT cases are spora...

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Parathyroidectomy for Primary Hyperparathyroidism in Octogenarians and Nonagenarians: A Risk–Benefit Analysis

Cited by 57 publications

References 20 publications

Parathyroidectomy in the Elderly: Analysis of 7313 Patients

Parathyroidectomy in the Elderly: Analysis of 7313 Patients

Persistent symptomatic improvement in the majority of patients undergoing parathyroidectomy for primary hyperparathyroidism

Current Concepts in the Presentation, Diagnosis and Management of Primary Hyperparathyroidism

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