Annals of Surgical Oncology

, Volume 20, Issue 13, pp 4195–4199 | Cite as

Presentation, Management, and Outcomes of Hyperparathyroidism in Octogenarians and Nonagenarians

  • Sarah C. Oltmann
  • David F. Schneider
  • Rebecca S. Sippel
  • Herbert Chen
Endocrine Tumors

Abstract

Background

Various elective surgical procedures are routinely performed on patients ≥80 years of age. With primary hyperparathyroidism (PHPT), surgical management is the only treatment. The goal of this study was to compare presentation and outcome of patients ≥80 to that of those <80 years of age.

Methods

Retrospective review of a prospectively collected database of all parathyroidectomies for PHPT performed at a university hospital. Patients ≥80 years at the time of surgery compared with patients <80 years.

Results

Over 13 years, 1,826 patients underwent parathyroidectomy for PHPT. A total of 154 patients were ≥80 years at the time of surgery (8.4 %), ranging from 80 to 91 years. Patients ≥80 years had higher serum PTH, creatinine and vitamin D levels and lower T scores. Calcium levels were similar. Patients ≥80 years had a greater history of hypertension, coronary artery disease, congestive heart failure, and stroke. Psychiatric disease was less common. Patients ≥80 years had the procedure under local anesthesia only more often. Use of a unilateral approach was equivalent. Rates of adenoma, double adenoma, and hyperplasia were comparable. Patients ≥80 years were observed overnight more frequently. Stays >24 h and disease recurrence and persistence, as well as morbidity rates, were all equivalent.

Conclusion

Disease presentation of PHPT in patients ≥80 is similar to <80. Despite increased comorbidities, parathyroidectomy is a safe procedure in this patient population with a noted equivalent complication rate to younger patients. Operative management remains the only treatment. Patient age should not be a deterrent to offer curative surgical intervention.

References

  1. 1.
    Werner CA. The Older Population: 2010. 2010 Census Briefs, C2010BR-09.Google Scholar
  2. 2.
    Kebebew E, Duh QY, Clark OH. Parathyroidectomy for primary hyperparathyroidism in octogenarians and nonagenarians. Arch Surg. 2003;138:867–71.PubMedCrossRefGoogle Scholar
  3. 3.
    Chiba Y, Satoh K, Udea S, Kanazawa N, Tamura Y, Horiuchi T. Marked improvement of psychiatric symptoms after parathyroidectomy in elderly primary hyperparathyroidism. Endocr J. 2007;54:379–83.PubMedCrossRefGoogle Scholar
  4. 4.
    Chen H, Parkerson S, Udelsman R. Parathyroidectomy in the elderly: do the benefits outweigh the risks? World J Surg. 1998;22:531–6.PubMedCrossRefGoogle Scholar
  5. 5.
    Udén P, Chan A, Duh QY, Siperstein A, Clark OH. Primary hyperparathyroidism in younger and older patients: symptoms and outcome of surgery. World J Surg. 1992;16:791–8.PubMedCrossRefGoogle Scholar
  6. 6.
    Olson J, Repplinger D, Bianco J, Chen H. Ex vivo radioactive counts and decay rates of tissues resected during radioguided parathyroidectomy. J Surg Res. 2006;136:187–91.PubMedCrossRefGoogle Scholar
  7. 7.
    Chen H, Pruhs Z, Starling JR, Mack E. Intraoperative parathyroid hormone testing improves cure rates in patients undergoing minimally invasive parathyroidectomy. Surgery. 2005;138:583–90.PubMedCrossRefGoogle Scholar
  8. 8.
    Chigot JP, Menegaux F, Achrafi H. Should primary hyperparathyroidism be treated surgically in elderly patients older than 75 years? Surgery. 1995;117:397–401.PubMedCrossRefGoogle Scholar
  9. 9.
    Mannix H, Pyrtek LJ, Crombie HD, Canalis E. Hyperparathyroidism in the elderly. Am J Surg. 1980;139:581–5.PubMedCrossRefGoogle Scholar
  10. 10.
    Ben Haim M, Zwas ST, Munz Y, Rosin D, Shabtai EL, Kuriansky J, et al. Focused, minimally invasive radio-guided parathyroidectomy: a feasible and safe option for elderly patients with primary hyperparathyroidism. Isr Med Assoc J. 2003;5:326–8.PubMedGoogle Scholar
  11. 11.
    Egan KR, Adler JT, Olson JE, Chen H. Parathyroidectomy for primary hyperparathyroidism in octogenarians and nonagenarians: a risk-benefit analysis. J Surg Res. 2007;140:194–8.PubMedCrossRefGoogle Scholar
  12. 12.
    Irvin GL, Carneiro DM. “Limited” parathyroidectomy in geriatric patients. Ann Surg. 2001;233:612–6.PubMedCrossRefGoogle Scholar
  13. 13.
    Mazeh H, Sippel RS, Chen H. The role of gender in primary hyperparathyroidism: same disease, different presentation. Ann Surg Oncol. 2012;19:2958–62.PubMedCrossRefGoogle Scholar
  14. 14.
    Adam MA, Untch BR, Danko ME, Stinnett S, Dixit D, Koh J, et al. Severe obesity is associated with symptomatic presentation, higher parathyroid hormone levels, and increased gland weight in primary hyperparathyroidism. J Clin Endocrinol Metab. 2010;95:4917–24.PubMedCrossRefGoogle Scholar
  15. 15.
    Tamura Y, Araki A, Chiba Y, Mori S, Hosoi T, Horiuchi T. Remarkable increase in lumbar spine bone mineral density and amelioration in biochemical markers of bone turnover after parathyroidectomy in elderly patients with primary hyperparathyroidism: a 5-year follow-up study. J Bone Miner Metab. 2007;25:226–31.PubMedCrossRefGoogle Scholar
  16. 16.
    Morris GS, Landry CL, Grubbs EG, Jimenez C, Busaidy NL, Perrier ND. Greater than age-predicted functional deficits in older patients with primary hyperparathyroidism. Endocr Pract. 2012;18:450–5.PubMedCrossRefGoogle Scholar
  17. 17.
    Chow WB, Rosenthal RA, Merkow RP, Ko CY, Esnaola NF. Optimal preoperative assessment of the geriatric surgical patient: a best practices guideline from the American College of Surgeons National Surgical Quality Improvement Program and the American Geriatrics Society. J Am Coll Surg. 2012;215:453–67.PubMedCrossRefGoogle Scholar

Copyright information

© Society of Surgical Oncology 2013

Authors and Affiliations

  • Sarah C. Oltmann
    • 1
  • David F. Schneider
    • 1
  • Rebecca S. Sippel
    • 1
  • Herbert Chen
    • 1
  1. 1.Section of Endocrine Surgery, Department of SurgeryUniversity of Wisconsin-MadisonMadisonUSA

Personalised recommendations