Randomized trial of parathyroidectomy in mild asymptomatic primary hyperparathyroidism: Patient description and effects on the SF-36 health survey

Talpos, Gary B.; Bone, Henry G.; Kleerekoper, Michael; Phillips, E.; Alam, Mohsin; Honasoge, Mahalakshmi; Divine, George; Rao, D. Sudhaker

doi:10.1067/msy.2000.110844

Cited by 157 publications

(112 citation statements)

References 11 publications

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“…Some randomized clinical trials have demonstrated an increase in BMD after PTx (68,69,137) (Table 8). In one study, after 2 years of surgical treatment, there was a significant increase in lumbar spine BMD in the surgically treated group, when compared with conservative treatment, in which BMD remained unchanged (1.01 ± 0.18 vs. 1.13 ± 0.19, p < 0.01) (68) (A-1B).…”

Section: Surgical Proceduresmentioning

confidence: 99%

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Diagnosis and management of primary hyperparathyroidism: a scientific statement from the Department of Bone Metabolism, the Brazilian Society for Endocrinology and Metabolism

Bandeira

Griz

Chaves

et al. 2013

Arq Bras Endocrinol Metab

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Objective: To conduct a literature review on the diagnosis and management of primary hyperparathyroidism including the classical hipercalcemic form as well as the normocalcemic variant. Materials and methods: This scientific statement was generated by a request from the Brazilian Medical Association (AMB) to the Brazilian Society for Endocrinology as part of its Clinical Practice Guidelines program. Articles were identified by searching in PubMed and Cochrane databases as well as abstracts presented at the Endocrine Society, Brazilian Society for Endocrinology Annual Meetings and the American Society for Bone and Mineral Research Annual Meeting during the last 5 years. Grading quality of evidence and strength of recommendation were adapted from the first report of the Oxford Centre for Evidence-based Medicine. All grades of recommendation, including "D" , are based on scientific evidence. The differences between A, B, C and D, are due exclusively to the methods employed in generating evidence. Conclusion:We present a scientific statement on primary hyperparathyroidism providing the level of evidence and the degree of recommendation regarding causes, clinical presentation as well as surgical and medical treatment. Arq Bras Endocrinol Metab. 2013;57(6):406-24 KeywordsPrimary hyperparathyroidism; normocalcemic primary hyperparathyroidism; diagnosis; treatment; parathyroidectomy ReSumoObjetivo: Conduzir uma atualização das últimas evidências científicas a respeito da apresentação, do diagnóstico e do manejo clínico e cirúrgico do hiperparatireoidismo primário clássico e normocalcêmico. Materiais e métodos: Este documento foi concebido pelo Departamento de Metabolismo Ósseo da Sociedade Brasileira de Endocrinologia e Metabologia (SBEM) a partir daquele oriundo do Programa de Diretrizes da Associação Médica Brasileira (AMB) da SBEM. Realizamos uma revisão dos artigos mais relevantes obtidos nos bancos de dados PubMed e Cochrane, além de abstracts apresentados nos encontros anuais da Endocrine Society, da Sociedade Brasileira de Endocrinologia e da American Society for Bone and Mineral Research dos últimos cinco anos, e classificamos as evidências em níveis de recomendações de acordo com a força científica por tipo de estudo, adaptando o primeiro relato do "Oxford Centre for Evidence-based Medicine" . Todos os graus de recomendação, incluindo-se o "D" , foram baseados em evidência científica, sendo as diferenças entre o A, B, C e D devidas exclusivamente ao desenho empregado na geração da evidência. Conclusão: Apresentamos uma atualização científica a respeito do hiperparatireoidismo primário, classificando e graduando em níveis de recomendações as principais evidências científicas sobre as suas causas, as variadas formas de apresentação, seu diagnóstico e tratamento. Arq Bras Endocrinol Metab. 2013;57(6):406-24 Descritores Hiperparatireoidismo primário; hiperparatireoidismo primário normocalcêmico; diagnóstico; tratamento; paratireoidectomia

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Section: Surgical Proceduresmentioning

confidence: 99%

“…Despite these limitations, some randomized stu dies have demonstrated a benefit of Ptx on neuropsychiatric symptoms in patients with asymptomatic PHPT (57,69,137) (Table 8).…”

Section: Diagnosis and Management Of Primary Hyperparathyroidismmentioning

confidence: 99%

Diagnosis and management of primary hyperparathyroidism: a scientific statement from the Department of Bone Metabolism, the Brazilian Society for Endocrinology and Metabolism

Bandeira

Griz

Chaves

et al. 2013

Arq Bras Endocrinol Metab

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“…Parathyroidectomy has been shown to improve the quality of life of these patients as measured by the SF-36 survey, a health survey that evaluates quality of life measures of bodily pain, general health, vitality, and mental health [15,16,18,36,70].…”

Section: Quality Of Life and Mental Healthmentioning

confidence: 99%

“…The literature contains many examples in which it is defined as asymptomatic disease, or pHPT wherein the calcium and/or PTH levels are above normal but are only slightly elevated [15][16][17][18]. For the purposes of this review, mild pHPT refers to patients with NCHPT or NHHPT.…”

Section: Introductionmentioning

confidence: 99%

Mild Primary Hyperparathyroidism: A Literature Review

Applewhite

Schneider

2014

The Oncologist

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The biochemical profile of classic primary hyperparathyroidism (pHPT) consists of both elevated calcium and parathyroid hormone levels. The standard of care is parathyroidectomy unless prohibited by medical comorbidities. Because more patients are undergoing routine bone density evaluation and neck imaging studies for other purposes, there is a subset of people identified with a biochemically mild form of the pHPT that expresses itself as either elevated calcium or parathyroid hormone levels. These patients often do not fall into the criteria for operation based on the National Institutes of Health consensus guidelines, and they can present a challenge of diagnosis and management. The purpose of this paper is to review the available literature on mild pHPT in an effort to better characterize this patient population and to determine whether patients benefit from parathyroidectomy. Evidence suggests that there are patients with mild pHPTwho have overt symptoms that are found to improve after parathyroidectomy. There is also a group of patients with biochemically mild pHPT who are found to progress to classic pHPT over time; however, it is not predictable which group of patients this will be. Early intervention for this group with mild pHPT may prevent progression of bone, psychiatric, and renal complications, and parathyroidectomy has proven safe in appropriately selected patients at high volume centers. The Oncologist 2014;19:919-929 Implications for Practice: Mild primary hyperparathyroidism (pHPT) is a disease that is being diagnosed with increased frequency; however, recommendations for treatment are not uniform. Current NIH guidelines do not recommend parathyroidectomy for these patients if they are asymptomatic; however, upon focused questioning, many of these patients are found to have subtle symptoms.The biochemically mild nature of the disease has been found to delay diagnosis and treatment, but after it is identified, surgery has shown to provide an improvement in quality of life and bone health. Although the current body of literature suggests that patients with mild pHPT benefit from parathyroidectomy, careful patient and surgeon selection is critical to ensuring safety and efficacy. Universal acceptance of parathyroidectomy in this subset of patients will require more high quality, prospective studies and improved definitions of long-term cure.

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“…As reported in a number of studies, patients with nephrolithiasis at presentation demonstrate no recurrence of renal stones after successful PTx, in contrast to a 75-100% chance of recurrent nephrolithiasis if not operated (14,17). Symptomatic and also 'asymptomatic' patients undergoing PTx have been reported to experience a significant improvement in various parameters of quality of life compared to patients who had no surgery (18)(19)(20)(21)(22).…”

Section: Introductionmentioning

confidence: 86%

No recurrence of sporadic primary hyperparathyroidism when cure is established 6 months after parathyroidectomy

Witteveen¹,

Kievit²,

Morreau

et al. 2010

European Journal of Endocrinology

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Objective: Cure rate for primary hyperparathyroidism (PHPT) is reported to be 94-100% 1 year after surgery, but recent data suggest recurrence in 4% of the patients 1-5 years post-operatively. The aim of our study was to establish the cure rate and its maintenance in the long-term after parathyroidectomy (PTx) in patients with sporadic PHPT. Design: Evaluation of recurrence in patients with sporadic hyperparathyroidism who underwent PTx 1-24 years prior to the study. Patients and methods: We identified 111 patients who underwent initial PTx between 1984 and 2008, and had no MEN-1, MEN-2, or CaR mutation; parathyroid carcinoma; a history of lithium use; or renal failure. Thirty-eight patients were lost to follow-up or were unwilling or unable to participate in the study. Cure was defined as maintenance of normal serum calcium and parathyroid hormone concentrations 6 months after PTx. Results: Cure was achieved in 68 of 73 patients studied (93%) and was sustained in all for 6G5 years. Conclusion: The cure rate of sporadic PHPT after initial surgery is 93%. When cure is achieved, this is sustained in 100% of the patients for up to 24 years post-operatively. Our data suggest that closer early follow-up is advocated in all patients undergoing PTx to definitively establish cure and to provide a safety net for those with residual gland pathology. The data do not support the need for long-term follow-up when cure is established 6 months after PTx.

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Randomized trial of parathyroidectomy in mild asymptomatic primary hyperparathyroidism: Patient description and effects on the SF-36 health survey

Cited by 157 publications

References 11 publications

Diagnosis and management of primary hyperparathyroidism: a scientific statement from the Department of Bone Metabolism, the Brazilian Society for Endocrinology and Metabolism

Diagnosis and management of primary hyperparathyroidism: a scientific statement from the Department of Bone Metabolism, the Brazilian Society for Endocrinology and Metabolism

Mild Primary Hyperparathyroidism: A Literature Review

No recurrence of sporadic primary hyperparathyroidism when cure is established 6 months after parathyroidectomy

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