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Asymptomatic primary hyperparathyroidism

World Journal of Surgery volume 15, pages 724–729 (1991)Cite this article

Abstract

The criteria used in selecting patients with asymptomatic hyperparathyroidism (HPT) for surgery remain controversial. Do patients with asymptomatic HPT have less severe disease (smaller glands and less derangement of biochemistry) than those with symptoms? We studied a consecutive series of 111 patients with HPT surgically treated and compared the symptomatic patients (n=83) and asymptomatic patients (n=28). There were no significant differences between the two patient groups with respect to age, serum calcium, PTH (intact 1–84), and excised gland weights (adenomas). Hypercalcemia was cured in all patients. The natural history of mild or asymptomatic HPT is unknown, but we summarize the current knowledge relating to mortality, cardiovascular/ renal disease, psychiatric and neuromuscular disorders, and bone disease. Symptoms of HPT do not correlate with the degree of biochemical and pathological derangement. Furthermore clinical assessment does not predict severity of disease and should not be the sole basis of selection for surgery. The results of surgery for primary HPT permit us to advocate a liberal approach to the selection of asymptomatic patients for operation.

Résumé

Les critères utilisés pour sélectioner les patients ayant une hyperparathyroÏdie (HPT) asymptomatique et susceptibles d'Être opérés, sont sujets à controverse. La question posée est: est-ce que l'HPT des patients asymptomatiques est moins sévère (glandes de plus petite taille et biologie moins perturbée) que l'HPT des patients symptomatiques? Nous avons étudié 111 patients consécutifs avec HPT traités chirurgicalement en comparant les résultats de 83 patients symptomatiques à 28 patients asymtomatiques. Il n'y avait aucune différence significative en ce qui concerne l'âge, la calcémie, le taux sérique de parathormone (PTH) comploids de glandes excisées (adénome). L'hypercalcémie a disparu chez tous les patients. L'histoire naturelle de l'HPT modérée ou asymptomatique est inconnue, mais nous avons essayé de résumer l'état actuel des connaissances sur ce sujet concernant la mortalité, le retentissement cardio-vasculaire, psychiatrique, neuromusculaire et osseux de la maladie. Les symptÔmes de l'HPT ne sont pas en rapport avec le degré des perturbations biologiques et les données anatomo-pathologiques. L'évaluation clinique ne permet pas de prédire la sévèrité de la maladie et ne doit pas Être le seul critère de sélection pour la chirurgie. Les résultats de la chirurgie pour l'HPT primitive nous incitent à préconiser une indication chirurgicale assez large dans la sélection des patients asymptomatiques.

Resumen

Los criterios para la selección de pacientes con hiperparatiroidismo primario (HPT) para cirugía son todavía motivo de controversia. ¿Tienen los pacientes con HPT asintomático enfermedad menos severa (glándulas menos grandes y menores alteraciones bioquímicas) que aquellos con síntomas? Estudiamos una serie de 111 pacientes con HPT tratados quirÚrgicamente y comparamos el grupo sintomático (83) con el grupo asintomático (28). No se hallaron diferencias significativas entre los dos grupos en cuanto a edad, calcio sérico, PTH (intacta 1–84) y peso de las glándulas resecadas (adenomas). La hipercalcemia fue curada en todos los pacientes. La historia natural del HPT leve o asintomática permanece desconocida, pero nos hemos propuesto resumir el conocimiento actual en relación con mortalidad, enfermedad cardiovascular/renal, alteraciones psiquiátricas y neuromusculares y enfermedad ósea. Los síntomas de HPT no se correlacionan con el grado de anormalidad bioquímica o patológica. Además, la valoración clínica no permite predecir la gravedad de la enfermedad y no debe constituir el Único factor de selección para cirugía. Los resultados de la cirugía en el HPT primario nos permite preconizar una política liberal en la selección de pacientes asintomáticos para operación.

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  1. Department of Surgery, University Hospital of Wales, Cardiff, Wales

    Barnard J. Harrison M.S., F.R.C.S. & Malcolm H. Wheeler M.D., F.R.C.S.

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  1. Barnard J. Harrison M.S., F.R.C.S.
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  2. Malcolm H. Wheeler M.D., F.R.C.S.
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Harrison, B.J., Wheeler, M.H. Asymptomatic primary hyperparathyroidism. World J. Surg. 15, 724–729 (1991). https://doi.org/10.1007/BF01665306

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Keywords

  • Adenoma
  • Hyperparathyroidism
  • Hypercalcemia
  • Primary Hyperparathyroidism
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