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Hyperparathyroidism in the Elderly Patient

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Abstract

Primary hyperparathyroidism is a common metabolic bone disease and currently presents a significant management dilemma. Most of the patients have few relevant symptoms and surgical parathyroidectomy offers the prospect of cure with freedom from the risk of long-term complications or the need for a follow-up. However, there is a natural reluctance to subject elderly patients to an operation where the balance of advantage is less clear. Advances in parathyroid imaging resulting in a greater use of targeted or focused parathyroidectomy has opened the way for the inclusion of less fit patients into the potentially operable category. However, there is still debate about whether these newer imaging techniques are sufficiently helpful and cost effective to warrant their use in all patients who may need parathyroid surgery. This has stimulated a debate about the indications for parathyroidectomy in the elderly and whether advances in medical therapy, which offset the end organ effects of excess parathyroid hormone, are of sufficient benefit to counteract this trend towards greater surgical intervention. These considerations mean that it is not possible to consider the merits of pharmacological therapy for primary hyperparathyroidism without reviewing the relative merits of minimally invasive and conventional surgery.

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No sources of funding were used to assist in the preparation of this review. The authors have no conflicts of interest that are directly relevant to the content of this review.

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  1. Departments of Nephrology, Surgery and Mineral Metabolism, City Hospital, Nottingham, UK

    Rebecca Sims, Charanjeit Ubhi &  David Hosking

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  1. Rebecca Sims
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Sims, R., Ubhi, C. & Hosking, D. Hyperparathyroidism in the Elderly Patient. Drugs Aging 21, 1013–1024 (2004). https://doi.org/10.2165/00002512-200421150-00004

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