Clinical presentation and management of patients with primary hyperparathyroidism in Italy

  • F. Saponaro
  • F. Cetani
  • A. Repaci
  • U. Pagotto
  • C. Cipriani
  • J. Pepe
  • S. Minisola
  • C. Cipri
  • F. Vescini
  • A. Scillitani
  • A. Salcuni
  • S. Palmieri
  • C. Eller-Vainicher
  • I. Chiodini
  • B. Madeo
  • E. Kara
  • E. Castellano
  • G. Borretta
  • L. Gianotti
  • F. Romanelli
  • V. Camozzi
  • A. Faggiano
  • S. Corbetta
  • L. Cianferotti
  • M. L. Brandi
  • M. L. De Feo
  • A. Palermo
  • G. Vezzoli
  • F. Maino
  • M. Scalese
  • C. Marcocci
Original Article
  • 52 Downloads

Abstract

Purpose

Evaluation of the phenotype of primary hyperparathyroidism (PHPT), adherence to International Guidelines for parathyroidectomy (PTx), and rate of surgical cure.

Method

From January 2014–January 2016, we performed a prospective, multicenter study in patients with newly diagnosed PHPT. Biochemical and instrumental data were collected at baseline and during 1-year follow-up.

Results

Over the first year we enrolled 604 patients (age 61 ± 14 years), mostly women (83%), referred for further evaluation and treatment advice. Five hundred sixty-six patients had sporadic PHPT (93.7%, age 63 ± 13  years), the remaining 38 (6.3%, age 41 ± 17  years) had familial PHPT. The majority of patients (59%) were asymptomatic. Surgery was advised in 281 (46.5%). Follow-up data were available in 345 patients. Eighty-seven of 158 (55.1%) symptomatic patients underwent PTx. Sixty-five (53.7%) of 121 asymptomatic patients with at least one criterion for surgery underwent PTx and 56 (46.3%) were followed without surgery. Negative parathyroid imaging studies predicted a conservative approach [symptomatic PHPT: OR 18.0 (95% CI 4.2–81.0) P < 0.001; asymptomatic PHPT: OR 10.8, (95% CI 3.1–37.15) P < 0.001). PTx was also performed in 16 of 66 (25.7%) asymptomatic patients without surgical criteria. Young age, serum calcium concentration, 24 h urinary calcium, positive parathyroid imaging (either ultrasound or MIBI scan positive in 75% vs. 16.7%, P = 0.001) were predictors of parathyroid surgery. Almost all (94%) of patients were cured by PTx.

Conclusions

Italian endocrinologists do not follow guidelines for the management of PHPT. Negative parathyroid imaging studies are strong predictors of a non-surgical approach. PTx is successful in almost all patients.

Keywords

Parathyroidectomy Parathyroid adenoma Serum calcium Parathyroid imaging 

Notes

Acknowledgements

The authors are very grateful to the participating patients for their cooperation. We wish to thank Drs Carmela Ostuni, Bari; Massimo Procopio, Torino; Alessandro Piovesan, Torino; Fochesato Elena Maria, Sondrio; Lettina Gabriele, Messina; Turiano Giuseppe, Messina; Roberto Allara, Vercelli; Vanessa Roncoroni, Ancona; Loredana Pagano, Novara; Federico Arecco, Torino; Marchese Lorenzo, Torino; Falcone Yolanda, Torino; Michele Zini, Reggio Emilia; Anna Ciampolillo, Bari; Fabio Ulivieri, Milano; Roberto Attanasio, Milano; Marco Sergio Massarotti, Milano; Andrea Lania, Milano; Valentina Albertino, Milano; Alberto Falchetti, Firenze; Vania Braga, Verona; Rizzato Margerita Treviso for participating in the study. This study has been conducted as part of the research projects of the Mineral and Bone Club of the Italian Society of Endocrinology.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Human research

This study has been approved by the appropriate institutional and/or national research ethics committee and has been performed in accordance with the ethical standards as laid down in the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.

Informed consent

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

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Copyright information

© Italian Society of Endocrinology (SIE) 2018

Authors and Affiliations

  • F. Saponaro
    • 1
  • F. Cetani
    • 1
  • A. Repaci
    • 2
  • U. Pagotto
    • 2
  • C. Cipriani
    • 3
  • J. Pepe
    • 3
  • S. Minisola
    • 3
  • C. Cipri
    • 4
  • F. Vescini
    • 4
  • A. Scillitani
    • 5
  • A. Salcuni
    • 5
  • S. Palmieri
    • 6
  • C. Eller-Vainicher
    • 6
  • I. Chiodini
    • 6
  • B. Madeo
    • 7
  • E. Kara
    • 7
  • E. Castellano
    • 8
  • G. Borretta
    • 8
  • L. Gianotti
    • 8
  • F. Romanelli
    • 9
  • V. Camozzi
    • 10
  • A. Faggiano
    • 11
  • S. Corbetta
    • 12
  • L. Cianferotti
    • 13
  • M. L. Brandi
    • 13
  • M. L. De Feo
    • 14
  • A. Palermo
    • 15
  • G. Vezzoli
    • 16
  • F. Maino
    • 17
  • M. Scalese
    • 18
  • C. Marcocci
    • 1
  1. 1.Department of Clinical and Experimental MedicineUniversity of PisaPisaItaly
  2. 2.Division of Endocrinology Department of Medical and Surgical SciencesUniversity of BolognaBolognaItaly
  3. 3.Department of Internal Medicine and Medical Disciplines‘Sapienza’ UniversityRomeItaly
  4. 4.Endocrinology and MetabolismUnit University-Hospital of UdineUdineItaly
  5. 5.Endocrinology Unit“Casa Sollievo della Sofferenza,” IRCCSSan Giovanni RotondoItaly
  6. 6.Unit of EndocrinologyFondazione IRCCS Cà Granda-Ospedale Maggiore PoliclinicoMilanItaly
  7. 7.Unit of EndocrinologyAzienda Ospedaliero-Universitaria di Modena, Ospedale Civile di BaggiovaraModenaItaly
  8. 8.Division of Endocrinology, Diabetes and MetabolismSanta Croce and Carle HospitalCuneoItaly
  9. 9.Department of Experimental MedicineSapienza University of RomeRomeItaly
  10. 10.Endocrine UnitUniversity of PadovaPaduaItaly
  11. 11.EndocrinologyFederico II University of NaplesNaplesItaly
  12. 12.Endocrinology Service, Department of Biomedical Sciences for HealthIRCCS Istituto Ortopedico GaleazziMilanItaly
  13. 13.Department of Internal MedicineUniversity of FlorenceFlorenceItaly
  14. 14.Endocrinology UnitCareggi Hospital and University of FlorenceFlorenceItaly
  15. 15.Department of Endocrinology and DiabetesUniversity Campus Bio-MedicoRomeItaly
  16. 16.Nephrology and Dialysis UnitIRCCS Ospedale San RaffaeleMilanItaly
  17. 17.Department of Medical, Surgical and Neurological SciencesUniversity of SienaSienaItaly
  18. 18.Institute of Clinical Physiology, National Council of ResearchPisaItaly

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