Abstract
Retrospective analysis has been performed on 108 consecutive patients operated for primary hyperparathyroidism (HPT) at 75 to 85 years of age (mean 79 years). The preperative serum calcium value averaged 2.99 mM, and six patients had hypercalcemic crisis. Psychic disturbances were seen in 60 patients (56%), 40% of whom demonstrated dementia. Skeletal and muscular complaints were registered in 29% and 19%, respectively, and only 6% were overtly asymptomatic. Cardiovascular diseases were presented by 69% of the patients, 13% had diabetes mellitus, and 26% were institutionalized prior to surgery. Bilateral neck exploration disclosed a single adenoma in 69%, which was of the oxyphil cell type in 13%, and water-clear (n=3) or chief cell hyperplasia in 27%. The total glandular weight averaged 1085 mg. Altogether 72 patients operated on after 1980 demonstrated a perioperative (30-day) mortality of 1.4%; the corresponding morbidity of 8.7% mainly included infections as well as a vocal cord paralysis in one patient and two incisional hematomas. Analysis for mean 3.1 years postoperatively displayed reversal of hypercalcemia in 95% of the patients; 2.8% of those operated after 1980 had persistent disease. Symptoms seemed to be alleviated in 62%, with a similar rate attained in patients with dementia. Altogether 60 patients died from mainly cardiovascular diseases mean 4.2 years after the operation. Those succumbing the first postoperative year (n=21) showed overrepresentation of cardiac diseases and diabetes mellitus. The results demonstrate prevalent psychic disturcbances, oxyphil adenomas, and multiglandular parathyroid disease in elderly patients with primary HPT and favor rather liberal application of parathyroid surgery among these individuals.
Résumé
Les dossìers de 108 patients consécutifs ayant entre 75 et 85 ans (moyen = 79), opérés pour hyperparathyroïdie primaire (HPP), ont été analysés rétrospectivement. La calcémie préopératoire était en moyenne de 2.99 mM et six patients ont eu une crise d'hypercalcémie. Les troubles psychiques ont été notées chez 60 patients (56%) et 40% ont eu une forme de démence. Des désordres squelettiques et musculaires ont été enregistrés respectivement chez 29% et 19% des patients, alors que seulement 6% étaient asymptomatiques. Des troubles cardiovasculaires ont été découverts chez 69% des patients, 13% avaient un diabète sucré et 26% étaient hospitalisés en psychiatrie avant la chirurgie. Une exploration cervicale bilatérale a permis de détecter un adénome solitaire chez 69% des patients, oxyphiles chez 13%, alors que l'hyperplasie “eau de roche” (n=3) ou de cellules principales a été retrouvée chez 27% des patients. Le poids total des glandes enlevées était de 1085 mg en moyenne. La mortalité périopératoire (à 30 jours) a été de 1.4% chez les 72 patients opérés après 1980, alors que la morbidité a été de 8.7% et a consisté essentiellement en des infections, un cas de paralysie récurentielle et deux hématomes de paroi. L'analyse postopératoire (recul moyen = 3.1 ans) a montré que l'hypercalcémie s'était corrigée chez 95% des patients alors que 2.8% de ceux opérés après 1980 avaient une HPP persistante. Les symptômes (incluant les cas de démence) se sont amendés chez 62% des patients. Au total, 60 patients sont morts de problèmes cardiovasculaires 4.2 ans en moyenne après l'intervention. La mortalité après la première année (n=21) était essentiellement en rapport avec des complications cardiovasculaires et le diabète. Ces résultats montrent une prévalence élevée des désordres psychiques, des adénomes oxyphiles, et une maladie parathyroïdienne multiglandulaire chez le patient âgé ayant une HPP et ils sont en faveur d'une solution chirurgicale chez cette population âgée chaque fois que possible.
Resumen
Se realizó un análisìs retrospectivo en 108 pacientes consecutivos operados por hiperparatiroidismo primario (HPT) a los 75–85 años de edad (media, 79 años). El nivel del calcio sérico preoperatorio tuvo un valor promedio de 2.99 mM, y 6 pacientes tuvieron crísis hipercalcémicas. Se presentaron alteraciones síquicas en 60 pacientes (56%) y 40% de allos exhibieron demencia. Síntomas esquelétìcos o musculares fueron registrados en 29% y 19%, respectívamente, y sólo 6% eran francamente asìntomáticos. Enfermedades cardiovasculares fueron registradas en 69% de los pacientes, diabetes mellitus en 13% y 26% fueron institucionalizados antes de la cirugía. La exploraciòn bilateral del cuello reveló adenoma único en 69%, siendo del tipo celular oxifílico en 13%, en tanto que se encontró hiperplasia de células claras o de células principales en 27%. El peso glandular total fue de 1.085 mg en promedio. Globalmente 72 pacientes operados después de 1980 registraron una mortalidad perioperatoria (30 días) de 1.4%, mientras la correspondiente morbilidad 8.7% incluyó principalmente infecciones, parálisis de una cuerda vocal y dos hematomas incisionales. El análisis efectuado a los 3 años postoperatorios en promedio, reveló reversión de la hipercalcemia en 95% de los pacientes, y que 2.8% de aquellos operados después de 1980 tenían enfermedad persistente. La mejoría de los síntomas pareció ocurrir en 62%, tasa que fue muy similar en los pacientes con demencia. Globalmente 60 pacientes murieron principalmente por enfermedades cardiovasculares, a los 4.2 años, en promedio, luego de la operación. Los que sucumbieron en el primer año postoperatorio (n=21) exhibieron mayor incidencia de las enfermedades cardíacas y de la diabetes mellitus. Los resultados demuestran prevalencia de las alteraciones síquicas, de los adenomas oxifílicos y de la enfermedad paratiroidea multiglandular en pacientes de edad avanzada con hiperparatiroidismo primario y dan apoyo a la aplicación mas bien liberal de la cirugía paratiroidea en estos individuos.
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Öhryall, U., Åkerström, G., Ljunghall, S. et al. Surgery for sporadic primary hyperparathyroidism in the elderly. World J. Surg. 18, 612–618 (1994). https://doi.org/10.1007/BF00353779
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DOI: https://doi.org/10.1007/BF00353779