Primary hyperparathyroidism across the ages: presentation and outcomes

Area of Science:

• Endocrinology
• Surgical Oncology
• Geriatric Medicine

Background:

• Primary hyperparathyroidism (PHPT) is often associated with middle age but occurs across the lifespan.
• Understanding age-related variations in PHPT presentation is crucial for timely diagnosis and treatment.

Purpose of the Study:

• To compare the clinical and biochemical characteristics of PHPT patients based on age at surgical referral.
• To evaluate age-specific differences in surgical management and outcomes for PHPT.

Main Methods:

• Retrospective analysis of a prospectively maintained database of adult patients undergoing parathyroid surgery for PHPT.
• Inclusion criteria: negative family history, no prior parathyroid surgery, and at least 6-month follow-up.
• Patients were stratified into age groups: ≤50, 51-60, 61-70, and >70 years.

Main Results:

• 1372 patients met inclusion criteria between 2001-2012.
• Female predominance increased with age; higher parathyroid hormone levels at age extremes.
• Younger patients exhibited higher serum calcium, urinary calcium, and T-scores, with increased vitamin D deficiency.
• Local anesthesia use rose with age, while outpatient parathyroidectomy decreased.
• Disease persistence and recurrence rates were low and did not significantly differ across age groups.

Conclusions:

• PHPT patients at the extremes of age present with more pronounced biochemical abnormalities compared to middle-aged individuals.
• Age should not be a barrier to parathyroidectomy evaluation for PHPT, as all age groups achieve successful treatment outcomes.
• Differential surgical referral patterns may contribute to observed age-related differences in presentation.