Abstract
Objective
Parathyroidectomy (PTx) improves quality of life (QoL) in patients with primary hyperparathyroidism (PHPT). Whether this effect is modified according to the patients’ age is unknown. The aim of this study was to evaluate the impact of age on the effect of PTx on QoL and frailty in patients with PHPT, six months post-PTx.
Methods
This was a prospective cohort study, including patients with PHPT, admitted from January 2016 to December 2019, divided into two categories: younger (≤ 65 years old) and older (> 65 years old). QoL was assessed with the Pasieka questionnaire (PAS-Q) two days pre- and six months post-operatively. Frailty was also assessed at the same time intervals, with the Frailty Index (FI).
Results
One hundred and thirty-four patients (younger group: 96 patients, mean age 50.4 ± 9.8 years; older group: 38 patients, mean age 72.1 ± 4.9 years) were included. PTx resulted in a significant reduction in PAS-Q score in both groups. Notably, a greater reduction in “mood swings”, “irritability”, “itchy skin” and “feeling thirsty” PAS-Q domains was observed in the younger group. In contrast, a greater decrease in “bone pain”, “tiredness”, “weakness”, “joint pain”, “getting off chair” and “headaches” items was observed in the older group. Moreover, PTx led to a decrease in FI only in this group.
Conclusions
PTx leads to an improvement in QoL both in older (> 65 years) and younger (≤ 65 years) patients with PHPT, attributed to a differential effect on PAS-Q items. Frailty improves only in the older group.
Similar content being viewed by others
References
Rao SD (2018) Epidemiology of parathyroid disorders. Best Pract Res Clin Endocrinol Metab 32:773–780
Yu N, Donnan PT, Murphy MJ, Leese GP (2009) Epidemiology of primary hyperparathyroidism in Tayside, Scotland, UK. Clin Endocrinol (Oxf) 71:485–493
Coker LH, Rorie K, Cantley L, Kirkland K, Stump D, Burbank N, Tembreull T, Williamson J, Perrier N (2005) Primary hyperparathyroidism, cognition, and health-related quality of life. Ann Surg 242:642–650
Bilezikian JP, Brandi ML, Eastell R, Silverberg SJ, Udelsman R, Marcocci C, Potts JT Jr (2014) Guidelines for the management of asymptomatic primary hyperparathyroidism: summary statement from the Fourth International Workshop. J Clin Endocrinol Metab 99:3561–3569
Wilhelm SM, Wang TS, Ruan DT et al (2016) The American association of endocrine surgeons guidelines for definitive management of primary hyperparathyroidism. JAMA Surg 151:959–968
Wu B, Haigh PI, Hwang R, Ituarte PH, Liu IL, Hahn TJ, Yeh MW (2010) Underutilization of parathyroidectomy in elderly patients with primary hyperparathyroidism. J Clin Endocrinol Metab 95:4324–4330
Anagnostis P, Vaitsi K, Veneti S, Potoupni V, Kenanidis E, Tsiridis E, Papavramidis TS, Goulis DG (2021) Efficacy of parathyroidectomy compared with active surveillance in patients with mild asymptomatic primary hyperparathyroidism: a systematic review and meta-analysis of randomized-controlled studies. J Endocrinol Invest 44:1127–1137
Ware JE, Snow KK, Kosinksi M et al (1993) SF-36 health survey: manual and interpretation guide. The Health Institute, New England Medical Center, Boston, MA
Pasieka JL, Parsons LL (1998) Prospective surgical outcome study of relief of symptoms following surgery in patients with primary hyperparathyroidism. World J Surg 22:513–518 (discussion 518-519)
Mihai R, Sadler GP (2008) Pasieka’s parathyroid symptoms scores correlate with SF-36 scores in patients undergoing surgery for primary hyperparathyroidism. World J Surg 32:807–814
Liu M, Sum M, Cong E et al (2020) Cognition and cerebrovascular function in primary hyperparathyroidism before and after parathyroidectomy. J Endocrinol Invest 43:369–379
Rockwood K, Song X, MacKnight C, Bergman H, Hogan DB, McDowell I, Mitnitski A (2005) A global clinical measure of fitness and frailty in elderly people. CMAJ 173:489–495
Voss L, Nobrega M, Bandeira L, Griz L, Rocha-Filho PAS, Bandeira F (2020) Impaired physical function and evaluation of quality of life in normocalcemic and hypercalcemic primary hyperparathyroidism. Bone 141:115583
Ejlsmark-Svensson H, Sikjaer T, Webb SM, Rejnmark L, Rolighed L (2019) Health-related quality of life improves 1 year after parathyroidectomy in primary hyperparathyroidism: a prospective cohort study. Clin Endocrinol (Oxf) 90:184–191
Quiros RM, Alef MJ, Wilhelm SM, Djuricin G, Loviscek K, Prinz RA (2003) Health-related quality of life in hyperparathyroidism measurably improves after parathyroidectomy. Surgery 134:675–681 (discussion 681-673)
Ryhanen EM, Heiskanen I, Sintonen H, Valimaki MJ, Roine RP, Schalin-Jantti C (2015) Health-related quality of life is impaired in primary hyperparathyroidism and significantly improves after surgery: a prospective study using the 15D instrument. Endocr Connect 4:179–186
Dombrowsky A, Borg B, Xie R, Kirklin JK, Chen H, Balentine CJ (2018) Why is hyperparathyroidism underdiagnosed and undertreated in older adults? Clin Med Insights Endocrinol Diabetes 11:1179551418815916
Tzikos G, Chorti A, Evangelos S et al (2021) Quality of life in patients with asymptomatic primary hyperparathyroidism after parathyroidectomy: a 3-year longitudinal study. Endocr Pract. https://doi.org/10.1016/j.eprac.2021.01.003
Vadhwana B, Currow C, Bowers D, Groot-Wassink T (2021) Impact on quality of life after parathyroidectomy for asymptomatic primary hyperparathyroidism. J Surg Res 261:139–145
Amstrup AK, Rejnmark L, Mosekilde L (2011) Patients with surgically cured primary hyperparathyroidism have a reduced quality of life compared with population-based healthy sex-, age-, and season-matched controls. Eur J Endocrinol 165:753–760
Blanchard C, Mathonnet M, Sebag F et al (2014) Quality of life is modestly improved in older patients with mild primary hyperparathyroidism postoperatively: results of a prospective multicenter study. Ann Surg Oncol 21:3534–3540
Egan KR, Adler JT, Olson JE, Chen H (2007) Parathyroidectomy for primary hyperparathyroidism in octogenarians and nonagenarians: a risk-benefit analysis. J Surg Res 140:194–198
Polistena A, Lucchini R, Monacelli M, Triola R, Avenia S, Barillaro I, Johnson LB, Sanguinetti A, Avenia N (2017) Current indications for surgical treatment of primary hyperparathyroidism in the elderly. Am Surg 83:296–302
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
On behalf of all authors, the corresponding author states that there is no conflict of interest to disclose.
Ethical approval
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.
Informed consent
Additional informed consent was obtained from all individual participants for whom identifying information is included in this article.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Supplementary Information
Below is the link to the electronic supplementary material.
Rights and permissions
About this article
Cite this article
Papavramidis, T.S., Anagnostis, P., Pliakos, I. et al. The impact of age on quality of life and frailty outcomes after parathyroidectomy in patients with primary hyperparathyroidism. J Endocrinol Invest 45, 797–802 (2022). https://doi.org/10.1007/s40618-021-01710-5
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s40618-021-01710-5