[Forming of opinion in medical decision making and primary hyperparathyroidism]

A recent symposium regarding primary hyperparathyroidism, pHPT, dealt with the issue of surgical treatment versus conservative monitoring. Studies from the past decade showed an increase in mortality for patients with both mild and symptomatic pHPT. There is a direct relationship between risk of death and severity of pHPT, and surgery favorably affects mortality. Patients with untreated mild pHPT show a slow increase in mortality over time. Cardiovascular and neuropsychiatric morbidity were also shown to be ameliorated after surgery. Generally, patients with pHPT benefit from surgery. Some disagreed in spite of substantial data, and advocated a less aggressive approach, yet management must be based on strictly medical reasoning and well-performed studies. Economics may influence what we might accomplish, but must not influence the decision as to what the medical objective should be.