Age-specific differences in parathyroidectomy after implementation of guidelines for primary hyperparathyroidism

Despite meeting guideline-based criteria for surgery, older adults with primary hyperparathyroidism (PHPT) undergo parathyroidectomy at lower rates. We aimed to evaluate age-specific differences in PHPT diagnosis, time to surgery, and surgical indications among patients offered parathyroidectomy.

Retrospective cohort study of adults with sporadic PHPT who underwent parathyroidectomy between 1/1/2017 and 12/31/2022 at a tertiary academic center was performed. Surgical indications were determined using the 2016 American Association of Endocrine Surgeons (AAES) and Fourth International Workshop guidelines. Complete preoperative evaluation was defined as documentation of corrected serum calcium, parathyroid hormone (PTH), 25-hydroxy vitamin D, estimated glomerular filtration rate (eGFR), bone imaging/dual-energy X-ray absorptiometry (DXA), and 24-hour urine calcium.

Among 266 patients (median age 63.2 years; 74.8% female), 145 (54.5%) were <65 years (median 54.9 years) and 121 (45.5%) were ≥65 years (median 71.4 years). Time from first calcium elevation to PTH testing was similar between groups. However, the median time from biochemical diagnosis to surgery was significantly longer in older adults (14.5 vs. 7.53 months, P<0.05). Patients ≥65 years were more likely to undergo surgery for bone disease (31.4% vs. 20.0%, P<0.05), have eGFR <60 mL/min/1.73 m² (43.8% vs. 13.1%, P<0.001), and less likely to have nephrolithiasis (29.8% vs. 43.3%, P<0.05). Only 32.3% of all patients received a complete preoperative evaluation, with no difference by age group (P=0.80).

Older adults experienced longer delays to parathyroidectomy despite comparable rates of guideline-based evaluation. They were more likely to present with bone complications and decreased renal function, highlighting the need for earlier identification and referral to mitigate long-term morbidity.