Ageing, parathyroid adenomas and cancer-related outcomes

This narrative review examines the literature on parathyroid disease in the context of ageing, focusing on parathyroid adenoma and parathyroid carcinoma. Parathyroid disease incidence increases with age. We reviewed the available literature on age-related changes in parathyroid physiology and the differences in clinical approach and outcomes in older adults. Available evidence suggests that mechanisms associated with parathyroid adenoma development include structural remodelling of the parathyroid gland, age-related renal function decline and somatic mutations. The evidence for these mechanisms comes from small-scale studies and would benefit from further research. The evidence available suggests that there are some clinical and biochemical differences in parathyroid adenoma presentation in older adults. It also suggests that older adults may be undertreated, with concerns around suitability for surgery driving this. Parathyroid carcinoma has very limited literature available for both its underlying pathophysiology and clinical outcomes. Parathyroid adenoma rarely transforms to parathyroid carcinoma. This literature review shows that ageing does have an impact on the development of parathyroid disease but that there is a lack of large-scale studies around this. We hope this review will help guide further research in this area and, thus, improve care of older adults.