Patient Frailty Should Be Used to Individualize Treatment Decisions in Primary Hyperparathyroidism

Seib, Carolyn D.; Chomsky-Higgins, Kathryn; Gosnell, Jessica E.; Shen, Wen T.; Suh, Insoo; Duh, Quan‐Yang; Finlayson, Emily

doi:10.1007/s00268-018-4629-3

Cited by 22 publications

(20 citation statements)

References 41 publications

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“…Cases with multiple tumours are particularly more complicated, as a fall in the intraoperative PTH to the lower end of a normal range cannot guarantee that all tumours have been removed [19][20][21]. A reduction in intraoperative PTH by more than 50% after the procedure is a predictive factor [22,23] and may be prevented by preoperative supplementation with bisphosphonates [24,25]. Age is not a relevant contributing factor for the occurrence of complications [26,27], while anesthesia can often cause sudden elevation of PTH levels in patients suffering from hyperparathyroidism [28,29] and can worsen renal functions [30,31].…”

Section: Discussionmentioning

confidence: 99%

Surgical Management of Primary Hyperparathyroidism—Clinicopathologic Study of 1019 Cases from a Single Institution

Gawrychowski

Kowalski

Buła

et al. 2020

JCM

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Background: Primary hyperparathyroidism (pHPT) is an endocrine disorder characterized by hypercalcemia and caused by the presence of disordered parathyroid glands. Parathyroidectomy is the only curative therapy for pHPT, but despite its high cure rate of 95–98%, there are still cases where hypercalcemia persists after this surgical procedure. The aim of this study was to present the results of a surgical treatment of patients due to primary hyperparathyroidism and failures related to the thoracic location of the affected glands. Methods: We present a retrospective analysis of 1019 patients who underwent parathyroidectomy in our department in the period 1983–2018. Results: Among the group of 1019 operated-on patients, treatment failed in 19 cases (1.9%). In 16 (84.2%) of them, the repeated operation was successful. In total, 1016 patients returned to normocalcemia. Conclusions: Our results confirm that parathyreoidectomy is the treatment of choice for patients with primary hyperparathyroidism. The ectopic position of the parathyroid gland in the mediastinum is associated with an increased risk of surgical failure. Most parathyroid lesions in the mediastinum can be safely removed from the cervical access.

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Section: Discussionmentioning

confidence: 99%

Surgical Management of Primary Hyperparathyroidism—Clinicopathologic Study of 1019 Cases from a Single Institution

Gawrychowski

Kowalski

Buła

et al. 2020

JCM

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“…Women account for the majority of patients with PHPT, with a female to male ratio as high as 3 or 4: 1. 20 In this study, bone pain was present in 83% of patients, 50% of patients presented fractures, and 37% had fatigue and were uncomfortable. Because of the long course of the disease, 13% of patients had severe bone damage and skeletal deformities.…”

Section: Discussionmentioning

confidence: 53%

Changes in bone mineral density after parathyroidectomy in patients with moderate to severe primary hyperparathyroidism

et al. 2020

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Objective Primary hyperparathyroidism (PHPT) is relatively common in China and results in severe damage to the skeletal system. This study aimed to investigate changes in bone mineral density (BMD) over 2 years in patients with PHPT after parathyroidectomy. Methods This retrospective cohort study included patients with PHPT who underwent parathyroidectomy between January 2010 and December 2015. BMD and T-scores and Z-scores of the lumbar spine (L1, L2, L3, and L4) and total hip (femoral neck, great trochanter, and Ward’s triangle) at baseline and 2 years after surgery were measured by dual-energy X-ray absorptiometry. Results Thirty patients with moderate to severe PHPT (17 men and 13 women) aged 38.90±15.48 years were included. BMD, and T-score and Z-score values at the lumbar spine and total hip at 6 months, 1 year, and 2 years after parathyroidectomy were significantly improved compared with preoperative values. Improvement in BMD was largest at L4 (46.7%) and smallest at L1 (37.4%) in the lumbar spine 2 years after parathyroidectomy. For the total hip, the increase in BMD was largest at Ward’s triangle (42.6%) and smallest at the femoral neck (37.5%). Conclusions BMD of the lumbar spine and total hip is improved after parathyroidectomy in patients with PHPT.

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“…However, they did not consider well-known complications such as laryngeal nerve injury and hypocalcemia, thus limiting comparability ( 22 ). In 2018, another study reported a higher risk of complications in frail and oldest patients >75 years ( 24 ). But again, as they also investigated non-surgical complications, comparability might be hindered.…”

Section: Discussionmentioning

confidence: 99%

“…Previous studies have reported conflicting findings concerning PTX-safety in elderly patients ( 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 ).…”

Section: Introductionmentioning

confidence: 97%

Safety of parathyroidectomy in older vs. younger patients with primary hyperparathyroidism

Monika

Ebrahimi

Christ

et al. 2021

Endocrine Connections

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Background: Primary hyperparathyroidism is a prevalent endocrinopathy for which surgery is the only curative option. Parathyroidectomy is primarily recommended in younger and symptomatic patients, while there are still concerns regarding surgical complications in older patients. We therefore assessed the association of age with surgical outcomes in patients undergoing parathyroidectomy in a large population in Switzerland. Methods: Population-based cohort study of adult patients with primary hyperparathyroidism undergoing parathyroidectomy in Switzerland between 2012 and 2018. The cohort was divided into four age groups (<50 years, 50-64 years, 65-74 years, ≥75 years). The primary outcome was a composite of in-hospital postoperative complications. Secondary outcomes were intensive care unit (ICU) admission, unplanned 30-day-readmission, and prolonged length of hospital stay. Results: We studied 2642 patients with a median (IQR) age of 62 (53 – 71) years. Overall, 111 patients had complications including surgical re-intervention, hypocalcemia, and vocal cord paresis. As compared to <50 year-old patients, older patients had no increased risk for in-hospital complications after surgery (50-64 years: OR 0.51 [95% CI 0.28 to 0.92]; 65-74 years: OR 0.72 [95% CI 0.39 to 1.33]; ≥75 years: OR 1.03 [95% CI 0.54 to 1.95]), respectively. There was also no association of age and rates of ICU-admission and unplanned 30-day-readmission, but oldest patients had longer hospital stays (OR 2.38 [95% CI 1.57 – 3.60]). Conclusion: ≥50 year-old patients undergoing parathyroidectomy had comparable risk of in-hospital complications as compared with younger ones. These data support parathyroidectomy in even older patients with primary hyperparathyroidism as performed in clinical routine.

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Patient Frailty Should Be Used to Individualize Treatment Decisions in Primary Hyperparathyroidism

Cited by 22 publications

References 41 publications

Surgical Management of Primary Hyperparathyroidism—Clinicopathologic Study of 1019 Cases from a Single Institution

Surgical Management of Primary Hyperparathyroidism—Clinicopathologic Study of 1019 Cases from a Single Institution

Changes in bone mineral density after parathyroidectomy in patients with moderate to severe primary hyperparathyroidism

Safety of parathyroidectomy in older vs. younger patients with primary hyperparathyroidism

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