Surgical management of primary hyperparathyroidism: A single-center experience

Area of Science:

• Endocrinology
• Surgical Oncology
• Geriatric Medicine

Background:

• Primary hyperparathyroidism (PHPT) affects individuals across all age groups.
• Management strategies for minor-symptomatic or asymptomatic PHPT require age-specific considerations.
• Evaluating parathyroidectomy in young versus elderly PHPT patients is crucial for optimizing treatment guidelines.

Purpose of the Study:

• To compare the necessity, feasibility, safety, and outcomes of parathyroidectomy in young versus elderly patients with minor-symptomatic or asymptomatic PHPT.
• To assess age-related differences in the management and surgical outcomes of PHPT.
• To determine if parathyroidectomy is a viable and safe option for older adults with PHPT.

Main Methods:

• Retrospective review of 137 patients who underwent parathyroidectomy for PHPT (January 2005 - June 2016).
• Patients were categorized into two groups: young (<50 years) and old (≥50 years).
• Analysis included biochemical data, bone densitometry, surgical and pathology reports, and perioperative outcomes.

Main Results:

• Older patients had a longer average medical treatment course but a higher risk of new symptoms or complications during this period.
• No significant differences were observed in 30-day mortality, immediate complications, or follow-up duration between the age groups.
• Older patients showed a trend towards longer postoperative hospitalization, though not statistically significant.

Conclusions:

• Parathyroidectomy is a safe and feasible surgical option for older patients with PHPT, yielding outcomes comparable to younger individuals.
• Surgical intervention in older adults helps prevent the development or progression of PHPT-related symptoms and complications.
• Parathyroidectomy should be considered the recommended treatment for PHPT patients, regardless of age or initial symptom presentation, to ensure early intervention.