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Hyperparathyroidism in patients over 75: clinical characteristics and outcome. Is conservative treatment a safe alternative?
Maturitas ( IF 4.9 ) Pub Date : 2020-05-01 , DOI: 10.1016/j.maturitas.2020.02.010
Hadar Duskin-Bitan 1 , Nina Nemirovsky 2 , Ilana Slutzky-Shraga 1 , Alexander Gorshtein 1 , Hiba Masri-Iraqi 1 , Eyal Robenshtok 1 , Talia Diker-Cohen 3 , Joelle Singer 1 , Ilan Shimon 1 , Dania Hirsch 1 , Gloria Tsvetov 1
Affiliation  

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.

中文翻译:

75 岁以上患者的甲状旁腺功能亢进:临床特征和结果。保守治疗是一种安全的选择吗?

目标随着当前世界人口的老龄化,越来越多的老年人发现原发性甲状旁腺功能亢进症(PHPT)。然而,关于该组 PHPT 的表现和结果的数据很少。目的是描述在我们的内分泌诊所观察到的一组 75 岁或以上患有 PHPT 的患者。研究设计 对某三级医院内分泌门诊病历的回顾性分析。我们评估了 182 名 PHPT 患者,他们在最后一次随访时年龄在 75 岁或以上,全部在 65 岁或以上被诊断出来。在诊断和末次随访时比较实验室数据。结果 诊断时的平均年龄为 73 ± 4 岁,最后一次随访为 83 ± 4 年,平均随访时间为 11.3 ± 5.5 年。114 (63 %)、84 (46 %) 和 43 (24 %) 名患者诊断出骨质疏松症、骨折和肾结石,分别。总体而言,150 名患者有手术指征;其中,29 名接受甲状旁腺切除术的患者比未手术的患者年龄小,高钙尿症发生率更高。141 例未接受手术的患者在随访期间,血清和尿钙水平显着降低,维生素 D 水平在末次访视时升高(10.4 ± 0.5 mg/dl,161 ± 70 mg/24 h,69 ± 17 nmol/l,分别为 p < 0.01)与诊断时的水平(分别为 10.6 ± 0.2 mg/dl、223 ± 95 mg/24 h、53 ± 15 nmol/l,p = 0.001)相比。总体而言,182 名患者中有 38 名 (20 %) 在随访期间死亡;这些患者在诊断时明显年龄较大(76 ± 5 岁与 72 ± 4 岁),但实验室变量没有差异。结论 虽然大多数患者有手术的正式指征,少数接受甲状旁腺切除术。未接受手术的患者在随访期间血清和尿钙显着下降。我们的数据令人放心,至少支持考虑对这些患者进行保守治疗。
更新日期:2020-05-01
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