Older Patients With Asymptomatic Primary Hyperparathyroidism: Should Criteria for Surgery Be Expanded?

Area of Science:

• Endocrinology
• Surgical Oncology

Background:

• Primary hyperparathyroidism (PHPT) presents with diverse clinical manifestations.
• Current clinical practice guidelines dictate surgical referral for parathyroidectomy.
• Patient age and specific symptoms influence surgical candidacy.

Purpose of the Study:

• To evaluate surgical indications in patients over 50 undergoing parathyroidectomy for PHPT.
• To assess the impact of modifying current guidelines on surgical recommendations.

Main Methods:

• Retrospective review of 1182 patients aged 50+ undergoing parathyroidectomy for PHPT (2012-2020).
• Classification by guideline criteria (classic, asymptomatic, no criteria) and age groups.
• Analysis of common surgical indications and symptoms in relation to age.

Main Results:

• 31% had classic and 56% had asymptomatic indications for surgery.
• Hypercalcemia, osteoporosis, and nephrolithiasis were primary surgical drivers.
• Neurocognitive symptoms and osteopenia were prevalent in patients not meeting criteria, irrespective of age.

Conclusions:

• Expanding PHPT guidelines to include a wider age range and symptoms like osteopenia and neurocognitive issues may facilitate earlier surgical referral.
• This broader approach could enhance timely evaluation and definitive treatment for PHPT patients.