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Primary hyperparathyroidism in younger and older patients: Symptoms and outcome of surgery

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Abstract

Two-hundred and fifty patients undergoing initial exploration for primary hyperparathyroidism were analyzed for differences in clinical presentation, biochemical status, pathology, and outcome of surgery. In patients <60 years of age (younger patients, n=119) the most common preoperative symptoms and signs were fatigue (40.3%), bone pain (33.6%), renal stones (31.0%), hypertension (27.7%), and psychiatric illness (27.7%). In patients ≥60 years of age (older patients, n=131) the most frequent symptoms and signs were hypertension (46.6%), fatigue (35.1%), bone pain (30.5%), muscle weakness (28.2%), and joint pain (22.9%). Renal stones were 2.6 times more common (p<0.001, chi2) in younger patients and hypertension 1.7 times more common (p<0.05, chi2) in older patients. There was no significant difference in the preoperative and postoperative laboratory values typically associated with primary hyperparathyroidism. Double adenomas were more common in older (9.2%) than in younger patients (2.5%,p<0.05, chi2). Surgical cure was obtained in 98.8% of patients, and after parathyroidectomy 83% of the younger and 82% of the older patients experienced substantial relief of pre-operative symptoms. Specific questioning revealed most patients to be symptomatic and older patients appear to receive the same clinical and metabolic benefits from parathyroidectomy as younger patients.

Résumé

Deux cent et cinquante patients ayant eu une exploration initiale d'hyperparathyroïdien primaire ont été analysés pour faire apparaître les différences de présentation clinique, les examens de laboratoire, les données anatomo-pathologiques et les résultats de la chirurgie. Chez les patients âgés de moins de 60 ans (patients jeunes n=119) les signes et symptômes les plus fréquents étaient la fatigue (40.3%), les douleures osseuses (33.6%), la lithiase rénale (31%), l'hypertension (27.7%) et les désordres psychiatriques (27.7%). Chez les patients de 60 ans ou plus (patients âgés) (n=31), les symptômes et signes les plus fréquents étaient l'hypertension (46.6%), la fatigue (35.1%), les douleurs osseuses (30.5%), la faiblesse musculaire (28.2%) et les douleurs articulaires (22.9%). La lithiase rénale a été 26 fois plus fréquente (p<0.001). chez les “jeunes” par rapport aux “vieux” (p<0.05). Il n'y avait pas de différence significative des valeurs pré ou postopératoires caractéristiques de l'hyperparathyroïdie primaire. Les adénomes doubles étaient plus fréquents chez les âgés (9.2%) que chez les jeunes (2.5%) (p<0.05). La guérison a été obtenue chez 98.8% des patients et, aprés une parathyroïdectomie, 83% des jeunes et 82% des plus âgés ont eu une amélioration importante de leurs symptômes préopératoires. En conclusion, la plupart des patients étaient symptomatiques et les sujets plus âgés ont eu les mêmes bénéfices cliniques et métaboliques que les plus jeunes.

Resumen

Se analizaron 250 pacientes sometidos a exploración inicial por hiperparatiroidismo (HPT) primario para determinar diferencias en la presentación clínica, estado bioquímico, patología y resultado de la cirugía. En los pacientes menores de 60 (pacientes jóvenes; n=119) los sintomas y signos preoperatorios más comunes fueron la fatiga (40.3%), el dolor óseo (33.6%), lo cálculos renales 31.0%), la hipertensión (27.7%) y la enfermedad psiquiátrica (27.7%). En los pacientes de 60 años o mayores (pacientes ancianos; n=131) los síntomas y signos más frecuentes fueron la hipertensión (46.6%), la fatiga (35.1%), el dolor óseo (30.5%), la debilidad muscular (28.2%) y el dolor articular (22.9%). Los cálculos renales fueron 2.6 veces más comunes (p<0.001; chi2) en los pacientes jóvenes y la hipertensión 1.7 veces más comun (p<0.05; chi2) en los pacientes ancianos. No se encomraron diferencias significativas en los valores pre y postoperatorios de laboratorio típicamente asociados con HPT primario. Los adenomas dobles aparecieron más comunes en los pacientes ancianos (9.2%) que en los jóvenes (2.5%;p<0.05 chi2). Se logró la curación quirúrgica en 98.8% de los pacientes, y después de la paratiroidectomía el 83% de los jóvenes 82% de los ancianos manifestaron mejoría sustancial de los síntomas preoperatorios. El interrogatorio específico reveló que la mayoría de los pacientes con HPT son sintomáticos y que los pacientes de mayor edad parecen recibir los mismos beneficios clínicos metabólicos de la paratiroidectomía que los pacientes más jóvenes.

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References

  1. Heath, H. III, Hodgson, S.E., Kennedy, M.A.: Primary hyperparathyroidism: Incidence, morbidity and potential economic impact in a community. N. Engl. J. Med.302:189, 1980

    PubMed  Google Scholar 

  2. Boonstra, C.E., Jackson, C.E.: Serum calcium survey for hyperparathyroidism: Results in 50000 clinic patients. Am. J. Clin. Pathol.55:523, 1971

    PubMed  Google Scholar 

  3. Palmér, M., Ljunghall, S., Åkerström, G., Adami, H., Bergström, R., Grimelius, L., Rudberg, C., Johansson, H.: Patients with primary hyperparathyroidism operated on over a 24 year period: Temporal trends of clinical and laboratory findings. J. Chronic Dis.40:121, 1987

    PubMed  Google Scholar 

  4. Hedbäck, G., Tisell, L.-E., Bengtsson, B.-A., Hedman, I., Odén, A.: Premature death in patients operated on for primary hyperparathyroidism. World J. Surg.14:829, 1990

    PubMed  Google Scholar 

  5. Clark, O.H., Duh, Q.-Y., Siperstein, A., Wilkes, W.: Diagnosis and management of asymptomatic hyperparathyroidism: Safety, efficacy and deficiencies in our knowledge. J. Bone Miner. Res. (in press)

  6. Tibblin, S., Bondeson, A.G., Udén, P.: Current trends in the surgical treatment of the solitary parathyroid adenoma: A questionnaire study from 53 departments of surgery in 14 countries. Eur. J. Surg.157:103, 1991

    PubMed  Google Scholar 

  7. Hellström, J., Ivemark, B.I.: Primary hyperparathyroidism: Clinical and structural findings in 138 cases. Acta Chir. Scand. Suppl.294:1, 1962

    Google Scholar 

  8. Cope, O.: The story of hyperparathyroidism at the Massachusetts General Hospital. N. Engl. J. Med.274:1174, 1966

    PubMed  Google Scholar 

  9. Kristoffersson, A., Dahlgren, S., Granstrand, B., Järhult, J.: Primary hyperparathyroidism in Northern Sweden. Surg. Gynecol. Obstet.164:119, 1987

    PubMed  Google Scholar 

  10. Nikkilä, M.T., Saaristo, J.J., Koivula, T.A.: Clinical and biochemical features in primary hyperparathyroidism. Surgery105:148, 1989

    PubMed  Google Scholar 

  11. Pyrah, L.N., Hodgkinsson, A., Anderson, C.K.: Primary hyperparathyroidism. Br. J. Surg.53:245, 1966

    PubMed  Google Scholar 

  12. Adami, S., O'Riordan, S.L.H.: Primary hyperparathyroidism. In Metabolic Bone and Stone Diseases, 2nd edition, B.E.C. Nordin, editor, Edinburgh, London, Melbourne, New York, Churchill Livingston, 1984, pp. 112–158

    Google Scholar 

  13. Niederle, B., Roka, R., Woloszczuk, W., Klaushofer, K., Kovarik, J., Schernthaner, G.: Successful parathyroidectomy in primary hyperparathyroidism: A clinical follow-up study of 212 consecutive patients. Surgery102:903, 1987

    PubMed  Google Scholar 

  14. Dotzenrath, C., Goretzki, P.E., Röher, H.D.: West Germany: Still an underdeveloped country in the diagnosis and early treatment of primary hyperparathyroidism? World J. Surg.14:660, 1990

    PubMed  Google Scholar 

  15. Bilezikian, J.P.: The medical management of primary hyperparathyroidism. Ann. Intern. Med.96:198, 1982

    PubMed  Google Scholar 

  16. Duh, Q.-Y., Morris, D.C., Arnaud, C., Clark, O.H.: Decrease in serum uric acid level following parathyroidectomy in patients with primary hyperparathyroidism. World J. Surg.10:729, 1986

    PubMed  Google Scholar 

  17. Geelhoed, G.W., Kelly, T.R.: Pseudogout as a clue and complication in primary hyperparathyroidism. Surgery106:1036, 1989

    PubMed  Google Scholar 

  18. Linos, D.A., van Heerden, J.A., Abboud, C.F., Edis, A.J.: Primary hyperparathyroidism and peptic ulcer disease. Arch. Surg.113:384, 1978

    PubMed  Google Scholar 

  19. Cope, O., Culver, P.J., Mixter, C.G. Jr., Nardi, G.L.: Pancreatitis: Diagnostic clue to hyperparathyroidism. Ann. Surg.145:857, 1957

    PubMed  Google Scholar 

  20. Kelly, T.R.: Relationship of hyperparathyroidism to pancreatitis. Arch. Surg.97:267, 1968

    PubMed  Google Scholar 

  21. Clark, O.H.: Hyperparathyroidism and pancreatitis. J.A.M.A.244:2413, 1980

    Google Scholar 

  22. Ljunghall, S., Lithell, H., Vessby, B., Wide, L.: Glucose and lipoprotein metabolism in primary hyperparathyroidism: Effects of parathyroidectomy. Acta Endocrinol. (Copenh.)89:580, 1978

    Google Scholar 

  23. Ljunghall, S., Palmér, M., Åkerström, G., Wide, L.: Diabetes mellitus, glucose tolerance and insulin response to glucose in patients with primary hyperparathyroidism before and after parathyroidectomy. Eur. J. Clin. Invest.13:373, 1983

    PubMed  Google Scholar 

  24. Sivula, A., Ronni-Sivula, H.: The changing picture of primary hyperparathyroidism in the years 1956–1979. Ann. Chir. Gynaecol.73:319, 1984

    PubMed  Google Scholar 

  25. Wallfelt, C., Ljunghall, S., Bergström, R., Rastad, J., Åkerström, G.: Clinical characteristics and surgical treatment of sporadic primary hyperparathyroidism with emphasis on chief cell hyperplasia. Surgery107:13, 1990

    PubMed  Google Scholar 

  26. Paterson, C.R., Burns, J., Mowat, E.: Long term follow-up of untreated primary hyperparathyroidism. Br. Med. J.289:1261, 1984

    Google Scholar 

  27. Browder, W., Rakinic, J., Schlecter, R., Krementz, E.T.: Primary hyperparathyroidism in the seventies: A decade of change? Am. J. Surg.146:360, 1983

    PubMed  Google Scholar 

  28. Farnebo, L.O., Trigonis, C., Forsgren, L., Granberg, P.-O., Hamberger, B.: Surgery for primary hyperparathyroidism: Experience with 400 patients during 10 years (1972–1981). Acta Chir. Scand. Suppl.520:11, 1984

    PubMed  Google Scholar 

  29. Brothers, T.E., Thompson, N.W.: Surgical treatment of primary hyperparathyroidism in elderly patients. Acta Chir. Scand.153:175, 1987

    PubMed  Google Scholar 

  30. van Heerden, J.A., Segura, J.W., Grant, C.S.: Primary hyperparathyroidism and urolithiasis: Concomitant surgical management. Surgery106:992, 1989

    PubMed  Google Scholar 

  31. Jabbour, N., Corvilain, J., Fuss, M., Kinnaert, P., Van Geertruyden, J.: The natural history of renal stone disease after parathyroidectomy for primary hyperparathyroidism. Surg. Gynecol. Obstet.172:25, 1991

    Google Scholar 

  32. Johansson, H., Thorén, L., Werner, I.: Hyperparathyroidism: Clinical experiences from 208 cases. Ups. J. Med. Sci.77:41, 1972

    PubMed  Google Scholar 

  33. Taylor, G.W.: Surgery of parathyroid disease. Br. J. Surg.67:732, 1980

    PubMed  Google Scholar 

  34. Hines, J.R., Atiyah, R., Kliefoth, J., Beal, J.M.: Hyperparathyroidism: Problems in surgical management. Am. J. Surg.144:504, 1982

    PubMed  Google Scholar 

  35. Dalén, N., Hjern, B.: Bone mineral content in patients with primary hyperparathyroidism without radiological evidence of skeletal change. Acta Endocrinol.75:297, 1974

    PubMed  Google Scholar 

  36. Kaplan, R.A., Snyder, W.H., Stewart, A., Pyk, C.Y.C.: Metabolic effects of parathyroidectomy in asymptomatic primary hyperparathyroidism. J. Clin. Endocrinol. Metab.42:415, 1976

    PubMed  Google Scholar 

  37. Graham, J.J., Harding, P.E., Hoare, L.L., Thomas, D.W., Wise, P.H.: Asymptomatic hyperparathyroidism: An assessment of operative intervention. Br. J. Surg.67:115, 1980

    PubMed  Google Scholar 

  38. Russel, C.F., Edis, A.J.: Surgery for primary hyperparathyroidism: Experience with 500 consecutive cases and evaluation of the role of surgery in the asymptomatic patient. Br. J. Surg.69:244, 1982

    PubMed  Google Scholar 

  39. Dolgin, C., Lo Gerfo, P., Livolsi, V., Feind, C.: Twenty-five years experience with primary hyperparathyroidism at Columbia Presbyterian Medical Center. Head Neck Surg.2:92, 1979

    PubMed  Google Scholar 

  40. Lafferty, F.W.: Primary hyperparathyroidism: Changing clinical spectrum, prevalence of hypertension and discriminant analysis of laboratory tests. Arch. Intern. Med.141:1761, 1981

    PubMed  Google Scholar 

  41. Trigonis, C., Hamberger, B., Farnebo, L.-O., Abarca, J., Granberg, P.-O.: Primary hyperparathyroidism: Changing trends during 50 years. Acta Chir. Scand.149:675, 1983

    PubMed  Google Scholar 

  42. Christensson, T., Hellström, K., Wengle, B.: Blood pressure in subjects with hypercalcemia and primary hyperparathyroidism detected in a health screening program. Eur. J. Clin. Invest.7:109, 1977

    PubMed  Google Scholar 

  43. Ronni-Sivula, H.: Causes of death in patients previously operated on for primary hyperparathyroidism. Ann. Chir. Gynaecol.74:13, 1985

    PubMed  Google Scholar 

  44. Palmér, M., Adami, H.O., Bergström, R., Åkerström, G., Ljunghall, S.: Mortality after surgery for primary hyperparathyroidism: A follow-up of 441 patients operated on from 1956 to 1979. Surgery102:1, 1987

    PubMed  Google Scholar 

  45. Tibblin, S., Pålsson, N., Rydberg, J.: Hyperparathyroidism in the old age. Ann. Chir. Gynaecol.72:135, 1983

    PubMed  Google Scholar 

  46. Peskin, G.W., Greenburg, A.G., Salt, R.P.: Expanding indications for early parathyroidectomy in the elderly female. Am. J. Surg.136:45, 1978

    PubMed  Google Scholar 

  47. Nudelman, I., Deutsch, A.A., Reiss, R.: Surgical treatment of primary hyperparathyroidism in the elderly patient. Isr. J. Med. Sci.19:150, 1983

    PubMed  Google Scholar 

  48. Joborn, J., Hetta, J., Palmér, M., Åkerström, G., Ljunghall, S.: Psychiatric symptomatology in patients with primary hyperparathyroidism. Ups. J. Med. Sci.91:77, 1986

    PubMed  Google Scholar 

  49. Cogan, M.G., Covey, C.M., Arieff, A.I., Wisniewski, A., Clark, O.H.: Central nervous system manifestations of hyperparathyroidism. Am. J. Med.65:963, 1978

    PubMed  Google Scholar 

  50. Joborn, C., Hetta, J., Frisk, P., Palmér, M., Åkerström, G., Ljunghall, S.: Primary hyperparathyroidism in patients with organic brain syndrome. Acta Med. Scand.219:91, 1985

    Google Scholar 

  51. Joborn, C., Hetta, J., Lind, J., Rastad, J., Åkerström, G., Ljunghall, S.: Self-rated psychiatric symptoms in patients with primary hyperparathyroidism. Surgery105:72, 1989

    PubMed  Google Scholar 

  52. Ljunghall, S., Åkerström, G.: Urate metabolism in primary hyperparathyroidism. Urol. Int.37:73, 1982

    PubMed  Google Scholar 

  53. Wilder, W.T., Frame, B., Haubrich, W.S.: Peptic ulcer in primary hyperparathyroidism. Ann. Intern. Med.55:885, 1961

    PubMed  Google Scholar 

  54. Ellis, C., Nikoloff, D.M.: Hyperparathyroidism and peptic ulcer disease. Arch. Surg.96:114, 1968

    PubMed  Google Scholar 

  55. Ostrow, J.D., Blanshard, G., Gray, S.J.: Peptic ulcer in primary hyperparathyroidism. Am. J. Med.29:769, 1960

    PubMed  Google Scholar 

  56. Rogers, H.M., Keating, R.F. Jr., Morlock, C.G., Barker, N.W.: Primary hypertrophy and hyperplasia of parathyroid glands associated with duodenal ulcer: Report of additional case, with special reference to metabolic, gastrointestinal and vascular manifestations. Arch. Intern Med.79:307, 1947

    Google Scholar 

  57. Majevski, J.T., Wilson, S.D. The MEA-I syndrome: An all or none phenomenom? Surgery86:475, 1979

    PubMed  Google Scholar 

  58. Duh, Q.-Y., Haberger, C.P., Geist, R., Gamsu, G., Goodman, P.C., Gooding, G.A.W., Clark, O.H.: Carcinoid tumors associated with multiple endocrine neoplasia syndromes. Am. J. Surg.154:142, 1987

    PubMed  Google Scholar 

  59. Bess, M.A., Edis, A.J., van Heerden, J.A.: Hyperparathyroidism and pancreatitis: Chance or a causal association? J.A.M.A.243:246, 1980

    PubMed  Google Scholar 

  60. Pratley, S.K., Posen, C., Reeve, T.S.: Primary hyperparathyroidism: Experiences with 60 patients. Med. J. Aust.1:421, 1973

    PubMed  Google Scholar 

  61. Romanus, R., Heimann, P., Nilsson, O., Hansson, G.: Surgical treatment of hyperparathyroidism. Prog. Surg.12:22, 1973

    PubMed  Google Scholar 

  62. Watson, G.K., van Heerden, J.A., Grant, C.S., Klee, G.K.: Postoperative hyperamylasemia, pancreatitis and primary hyperparathyroidism. Surgery96:1151, 1984

    PubMed  Google Scholar 

  63. White, T.T.: Pancreatitis, London, Edward Arnold Publisher, 1966

    Google Scholar 

  64. Duh, Q.-Y., Arnaud, C.D., Levin, K.E., Clark, O.H.: Parathyroid hormone: Before and after parathyroidectomy. Surgery100:1021, 1986

    PubMed  Google Scholar 

  65. Goltzman, D., Gomolin, H., DeLean, A., Wexler, M., Meakins, J.L.: Discordant disappearance of bioactive and immunoreactive parathyroid hormone after parathyroidectomy. J. Clin. Endocrinol. Metab.58:70, 1984

    PubMed  Google Scholar 

  66. Lewin, I.G., Hendy, G.N., Papapoulos, S.E., Tomlinsson, S., O'Riordan, J.L.: Effect of renal function on renal responsiveness to parathyroid hormone in primary hyperparathyroidism and chronic renal failure. Eur. J. Clin. Invest.15:38, 1985

    PubMed  Google Scholar 

  67. Duh, Q.-Y., Udén, P., Clark, O.H.: Unilateral neck exploration for primary hyperparathyroidism. Decision analysis of a controversy. World J. Surg.16:654, 1992

    PubMed  Google Scholar 

  68. Harness, J.K., Ramsburg, S.R., Nishiyama, R.H., Thompson, N.W.: Multiple adenoma of the parathyroids: Do they exist? Arch. Surg.114:468, 1979

    PubMed  Google Scholar 

  69. Verdonk, C.A., Edis, A.J.: Parathyroid “double adenomas”: Fact or fiction? Surgery90:523, 1981

    PubMed  Google Scholar 

  70. Grimelius, L., Åkerström, G., Johansson, H., Ljunghall, S., Rastad, J.: The role of pathology in diagnosis and surgical decision-making. Prog. Surg.18:80, 1986

    Google Scholar 

  71. Tibblin, S., Bondeson, A.G., Bondeson, L., Ljungberg, O.: Surgical strategy in hyperparathyroidism due to solitary adenoma. Ann. Surg.200:776, 1984

    PubMed  Google Scholar 

  72. Bondeson, A.G., Bondeson, L., Ljungberg, O., Tibblin, S.: Fat staining in parathyroid disease: Diagnostic value and impact on surgical strategy: Clinicopathologic analysis of 191 cases. Hum. Pathol.16:1255, 1985

    PubMed  Google Scholar 

  73. Savata, R.M., Beahrs, O.H., Scholz, D.A.: Success rate of cervical exploration for hyperparathyroidism. Arch. Surg.110:625, 1975

    PubMed  Google Scholar 

  74. Bruining, H.A., van Houten, H., Juttman, J.R., Lamberts, S.W.J., Birkenhäger, J.C.: Results of operative treatment of 615 patients with primary hyperparathyroidism. World J. Surg.5:85, 1981

    PubMed  Google Scholar 

  75. Thompson, N.W., Eckhauser, F.E., Harness, J.K.: The anatomy of primary hyperparathyroidism. Surgery92:814, 1982

    PubMed  Google Scholar 

  76. Malmaeus, J., Granberg, P.O., Halvorsen, J., Åkerström, G., Johansson, H.: Parathyroid surgery in Scandinavia. Acta Chir. Scand.154:409, 1988

    PubMed  Google Scholar 

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  1. Surgical Service, Veterans Affair Medical Center, Mount Zion Medical Center of the University of California, San Francisco, California, U.S.A.

    Per Udén M.D., Allen Chan B.S., Quan-Yang Duh M.D., Allan Siperstein M.D. & Orlo H. Clark M.D.

  2. Department of Surgery, Lund University, Malmö, Sweden

    Per Udén M.D., Allen Chan B.S., Quan-Yang Duh M.D., Allan Siperstein M.D. & Orlo H. Clark M.D.

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Udén, P., Chan, A., Duh, QY. et al. Primary hyperparathyroidism in younger and older patients: Symptoms and outcome of surgery. World J. Surg. 16, 791–797 (1992). https://doi.org/10.1007/BF02067389

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