Presentation, Management, and Outcomes of Hyperparathyroidism in Octogenarians and Nonagenarians
Rent the article at a discountRent now
* Final gross prices may vary according to local VAT.Get Access
Various elective surgical procedures are routinely performed on patients ≥80 years of age. With primary hyperparathyroidism (PHPT), surgical management is the only treatment. The goal of this study was to compare presentation and outcome of patients ≥80 to that of those <80 years of age.
Retrospective review of a prospectively collected database of all parathyroidectomies for PHPT performed at a university hospital. Patients ≥80 years at the time of surgery compared with patients <80 years.
Over 13 years, 1,826 patients underwent parathyroidectomy for PHPT. A total of 154 patients were ≥80 years at the time of surgery (8.4 %), ranging from 80 to 91 years. Patients ≥80 years had higher serum PTH, creatinine and vitamin D levels and lower T scores. Calcium levels were similar. Patients ≥80 years had a greater history of hypertension, coronary artery disease, congestive heart failure, and stroke. Psychiatric disease was less common. Patients ≥80 years had the procedure under local anesthesia only more often. Use of a unilateral approach was equivalent. Rates of adenoma, double adenoma, and hyperplasia were comparable. Patients ≥80 years were observed overnight more frequently. Stays >24 h and disease recurrence and persistence, as well as morbidity rates, were all equivalent.
Disease presentation of PHPT in patients ≥80 is similar to <80. Despite increased comorbidities, parathyroidectomy is a safe procedure in this patient population with a noted equivalent complication rate to younger patients. Operative management remains the only treatment. Patient age should not be a deterrent to offer curative surgical intervention.
- Werner CA. The Older Population: 2010. 2010 Census Briefs, C2010BR-09.
- Kebebew, E, Duh, QY, Clark, OH (2003) Parathyroidectomy for primary hyperparathyroidism in octogenarians and nonagenarians. Arch Surg. 138: pp. 867-871 CrossRef
- Chiba, Y, Satoh, K, Udea, S, Kanazawa, N, Tamura, Y, Horiuchi, T (2007) Marked improvement of psychiatric symptoms after parathyroidectomy in elderly primary hyperparathyroidism. Endocr J. 54: pp. 379-383 CrossRef
- Chen, H, Parkerson, S, Udelsman, R (1998) Parathyroidectomy in the elderly: do the benefits outweigh the risks?. World J Surg. 22: pp. 531-536 CrossRef
- Udén, P, Chan, A, Duh, QY, Siperstein, A, Clark, OH (1992) Primary hyperparathyroidism in younger and older patients: symptoms and outcome of surgery. World J Surg. 16: pp. 791-798 CrossRef
- Olson, J, Repplinger, D, Bianco, J, Chen, H (2006) Ex vivo radioactive counts and decay rates of tissues resected during radioguided parathyroidectomy. J Surg Res. 136: pp. 187-191 CrossRef
- Chen, H, Pruhs, Z, Starling, JR, Mack, E (2005) Intraoperative parathyroid hormone testing improves cure rates in patients undergoing minimally invasive parathyroidectomy. Surgery. 138: pp. 583-590 CrossRef
- Chigot, JP, Menegaux, F, Achrafi, H (1995) Should primary hyperparathyroidism be treated surgically in elderly patients older than 75 years?. Surgery. 117: pp. 397-401 CrossRef
- Mannix, H, Pyrtek, LJ, Crombie, HD, Canalis, E (1980) Hyperparathyroidism in the elderly. Am J Surg. 139: pp. 581-585 CrossRef
- Ben Haim, M, Zwas, ST, Munz, Y, Rosin, D, Shabtai, EL, Kuriansky, J (2003) Focused, minimally invasive radio-guided parathyroidectomy: a feasible and safe option for elderly patients with primary hyperparathyroidism. Isr Med Assoc J. 5: pp. 326-328
- Egan, KR, Adler, JT, Olson, JE, Chen, H (2007) Parathyroidectomy for primary hyperparathyroidism in octogenarians and nonagenarians: a risk-benefit analysis. J Surg Res. 140: pp. 194-198 CrossRef
- Irvin, GL, Carneiro, DM (2001) “Limited” parathyroidectomy in geriatric patients. Ann Surg. 233: pp. 612-616 CrossRef
- Mazeh, H, Sippel, RS, Chen, H (2012) The role of gender in primary hyperparathyroidism: same disease, different presentation. Ann Surg Oncol. 19: pp. 2958-2962 CrossRef
- Adam, MA, Untch, BR, Danko, ME, Stinnett, S, Dixit, D, Koh, J (2010) Severe obesity is associated with symptomatic presentation, higher parathyroid hormone levels, and increased gland weight in primary hyperparathyroidism. J Clin Endocrinol Metab. 95: pp. 4917-4924 CrossRef
- Tamura, Y, Araki, A, Chiba, Y, Mori, S, Hosoi, T, Horiuchi, T (2007) Remarkable increase in lumbar spine bone mineral density and amelioration in biochemical markers of bone turnover after parathyroidectomy in elderly patients with primary hyperparathyroidism: a 5-year follow-up study. J Bone Miner Metab. 25: pp. 226-231 CrossRef
- Morris, GS, Landry, CL, Grubbs, EG, Jimenez, C, Busaidy, NL, Perrier, ND (2012) Greater than age-predicted functional deficits in older patients with primary hyperparathyroidism. Endocr Pract. 18: pp. 450-455 CrossRef
- Chow, WB, Rosenthal, RA, Merkow, RP, Ko, CY, Esnaola, NF (2012) Optimal preoperative assessment of the geriatric surgical patient: a best practices guideline from the American College of Surgeons National Surgical Quality Improvement Program and the American Geriatrics Society. J Am Coll Surg. 215: pp. 453-467 CrossRef
- Presentation, Management, and Outcomes of Hyperparathyroidism in Octogenarians and Nonagenarians
Annals of Surgical Oncology
Volume 20, Issue 13 , pp 4195-4199
- Cover Date
- Print ISSN
- Online ISSN
- Springer US
- Additional Links
- Industry Sectors