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Comparative efficacy of parathyroidectomy and active surveillance in patients with mild primary hyperparathyroidism: a systematic review and meta-analysis

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Abstract

Counseling for patients with primary hyperparathyroidism (PHPT) and mild hypercalcemia without indications for surgical intervention requires accurate estimates of the potential benefits of parathyroidectomy. We aim to summarize the available evidence regarding the benefits of parathyroidectomy that patients with mild PHPT without indications for surgery experience compared to observation. We searched multiple databases from inception to August 2015. We included randomized controlled trials (RCT) and observational studies that evaluated changes in bone health, quality of life or neuropsychiatric symptoms, or in the risk of nephrolithiasis, cardiovascular events, or death between patients undergoing parathyroidectomy or active surveillance. Eight studies were eligible. Risk differences were not significant, in part due to lack of events (fractures, nephrolithiasis, cardiovascular events, or deaths). No significant differences were observed across measures of bone health, quality of life, and neuropsychiatric symptoms. A single RCT evaluating bone mineral density (BMD) changes at 5 years found a small statistically significant effect favoring parathyroidectomy. Patients with mild PHPT without indications for surgery experience a limited number of adverse consequences during short-term follow-up limiting our ability to estimate the benefit of surgery during this timeframe. This information is helpful as these patients consider surgery versus active surveillance. Long-term data is warranted to determine who benefits in the long run from surgical intervention and the extent to which this benefit affects outcomes that matter to patients.

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Acknowledgments

We would like to thank the authors who responded to our request for further information: Drs. Okamoto T, Bollerslev J, Rao S, Grey A, and Nordentrom J.

This publication was made possible by CTSA Grant Number UL1 TR000135 from the National Center for Advancing Translational Sciences (NCATS), a component of the National Institutes of Health (NIH). Its contents are solely the responsibility of the authors and do not necessarily represent the official view of NIH.

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Authors and Affiliations

  1. Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Knowledge and Evaluation Research Unit, Mayo Clinic College of Medicine, 200 First St. SW, Rochester, MN, 55905, USA

    N. Singh Ospina, S. Maraka, A. E. Espinosa de Ycaza, S. Jasim, J. P. Brito, R. Wermers & V. Montori

  2. Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN, USA

    N. Singh Ospina, S. Maraka, R. Rodriguez-Gutierrez, M. Gionfriddo, A. Castaneda-Guarderas, J. P. Brito & V. Montori

  3. Endocrinology Division, Department of Internal Medicine, University Hospital Dr. Jose E. Gonzalez, Monterrey, Mexico

    R. Rodriguez-Gutierrez

  4. Mayo Graduate School, Mayo Clinic, Rochester, MN, 55905, USA

    M. Gionfriddo

  5. Unidad de Conocimiento y Evidencia, Universidad Peruana Cayetano Heredia, Lima, Peru

    A. Castaneda-Guarderas

  6. Division of Pediatric Endocrinology and Metabolism, Mayo Clinic, Rochester, MN, USA

    A. Al Nofal

  7. Sanford Children’s specialty Clinic, Sioux Falls, SD, USA

    A. Al Nofal

  8. Mayo Medical Libraries, Mayo Clinic, Rochester, MN, 55905, USA

    P. Erwin

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  1. N. Singh Ospina
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Correspondence to V. Montori.

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Conflicts of interest

Naykky Singh Ospina, Spyridoula Maraka, Rene Rodriguez-Gutierrez, Ana Espinosa De Ycaza, Sina Jasim, Michael Gionfriddo, Ana Castaneda-Guarderas, Juan P Brito, Alaa Al Nofal, Patricia Erwin, Robert Wermers, and Victor Montori declare that they have no conflict of interest.

Additional information

Specific remarks

Patients with mild PHPT without indications for surgery experience a limited number of adverse consequences during short-term follow-up. This information is helpful as these patients consider surgery versus active surveillance. Long-term data is warranted to determine who benefits in the long run from surgical intervention.

Electronic supplementary material

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Supplemental Table 1

Risk of bias in the included randomized clinical trials on parathyroidectomy versus active surveillance in mild uncomplicated primary hyperparathyroidism (DOCX 12.1 kb)

Supplemental Table 2

Risk of bias of the included observational studies in mild uncomplicated primary hyperparathyroidism (DOCX 14.0 kb)

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(DOCX 29.1 kb)

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Singh Ospina, N., Maraka, S., Rodriguez-Gutierrez, R. et al. Comparative efficacy of parathyroidectomy and active surveillance in patients with mild primary hyperparathyroidism: a systematic review and meta-analysis. Osteoporos Int 27, 3395–3407 (2016). https://doi.org/10.1007/s00198-016-3715-3

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