Old age is not a contra-indication for surgery in patients with primary hyperparathyroidism

Neck exploration for hyperparathyroidism is sometimes withheld from elderly patients out of concern for the risks. The question whether this concern is founded in fact was examined in a consecutive series of 18 patients aged 70 years or older who were operated for primary hyperparathyroidism in the period 1988-1993. The patients were referred by 6 institutions.

Thirteen patients were considered symptomatic and 5 asymptomatic. The most common presenting symptoms were fatigue (n = 8), skeletal changes (n = 4), bone pain (n = 4) and polyuria (n = 4). Urolithiasis occurred in 2 patients. After operation with excision of all enlarged parathyroid glands serum calcium concentrations normalised in all patients. There was no mortality and the only complication was a late haematoma in a patient who used anticoagulants. The median postoperative hospital stay was 5 days (range 2-8 days).

The high cure rate, the low morbidity, the low mortality and the short hospital stay favor neck exploration as the treatment of choice also in the elderly patient.