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Parathyroidectomy for primary hyperparathyroidism in the elderly: experience of a single endocrine surgery center

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Abstract

Background

Primary hyperparathyroidism is a common endocrine disease, and its incidence increases with age.

Aims

Our aim was to retrospectively evaluate the impact of age on patient outcomes following parathyroidectomy for primary hyperparathyroidism.

Methods

Two-hundred fifty-six consecutive patients undergoing parathyroidectomy with preoperative diagnosis of primary hyperparathyroidism were divided into three groups according to patient age: group A, ≤64 years; group B, 65–74 years; and group C, ≥75 years.

Results

Thyroid disease was associated with the hyperparathyroidism in 44 patients (28.2%) in group A, 34 (44.7%) in B, and 10 (41.7%) in C (p < 0.01). Minimally invasive parathyroidectomy was performed in 104 patients (66.7%) in group A, 35 (46.1%) in B, and 8 (33.3%) in C (p < 0.01). Conversion to bilateral exploration was carried out in five cases in group A (4.6%), three in B (8.3%), and two in C (20%). Multiglandular disease was observed in six patients (3.8%) in group A, seven (9.2%) in B, and five (20.8%) in C (p = 0.012). Mean postoperative stay was similar between groups; no major complications and no cases of mortality occurred.

Discussion

Multiglandular disease is more common in older patients than younger individuals, and minimally invasive approaches are less used in this patient group. Increased surgical risk and paucity of symptoms in these patients sometimes result in a delay in surgical treatment.

Conclusions

Parathyroidectomy is a safe and effective procedure to perform in elderly patients. Multiglandular disease was found to be more prevalent in older patients, but minimally invasive parathyroidectomy can be performed safely. Surgeons should consider parathyroidectomy in patients with primary hyperparathyroidism regardless of age.

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Abbreviations

PHPT:

Primary hyperparathyroidism

IOPTH:

Intraoperative parathyroid hormone assay

PTH:

Parathyroid hormone

US:

Ultrasound

PPV:

Positive predictive value

NPV:

Negative predictive value

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Authors and Affiliations

  1. Department of Surgical Sciences, University of Cagliari, S.S. 554, Bivio Sestu, 09042, Monserrato, CA, Italy

    Pietro Giorgio Calò, Fabio Medas, Giulia Loi, Giuseppe Pisano, Enrico Erdas & Angelo Nicolosi

  2. Department of Surgical Sciences, “Sapienza” University of Rome, Rome, Italy

    Salvatore Sorrenti

Authors
  1. Pietro Giorgio Calò
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  2. Fabio Medas
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  3. Giulia Loi
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  4. Giuseppe Pisano
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  5. Salvatore Sorrenti
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  6. Enrico Erdas
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  7. Angelo Nicolosi
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Correspondence to Pietro Giorgio Calò.

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All authors listed have contributed sufficiently to the project to be included as authors, and to the best of our knowledge, no conflicts of interest, financial or other, exist.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. For this type of study, formal consent is not required.

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The article does not contain any experiments involving animals.

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Informed consent was obtained from all participants included in the study.

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Calò, P.G., Medas, F., Loi, G. et al. Parathyroidectomy for primary hyperparathyroidism in the elderly: experience of a single endocrine surgery center. Aging Clin Exp Res 29 (Suppl 1), 15–21 (2017). https://doi.org/10.1007/s40520-016-0666-7

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  • DOI: https://doi.org/10.1007/s40520-016-0666-7

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