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Five-year longitudinal evaluation of mild primary hyperparathyroidism — medical treatment versus clinical observation
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Abstract
Introduction: Primary hyperparathyroidism (PHPT) is an increasingly common endocrine disorder. Most patients with PHPT do not have disease-specific symptoms. The management of these patients has been widely debated. Recent studies have shown the importance of following up asymptomatic patients in order to reduce co-morbidity. However, there are conflicting opinions as to medical management. The aim of our study was to compare the outcome of PHPT patients on antiresorptive therapy vs. observation only.
Material and methods: We longitudinally evaluated 157 PHPT patients (126 females) aged 22–90 years. Patients who did not undergo surgery were divided into two groups: those on anti-resorptive therapy (N = 52), and those without any treatment (N = 37). Patients who were disease-free after surgery (N = 50) served as controls.
Results: The values of serum calcium (S-Ca), parathyroid hormone (PTH) and indices of bone metabolism did not differ significantly among the three groups of subjects. No differences in 25(OH)-vitamin D levels were noted. Bone mineral density (BMD) was not significantly different at the spinal level. Finally, we found no evidence of an effect of medical treatment on quality of life (QoL). However, QoL significantly improved in the surgery group after parathyroidectomy (PTX).
Conclusions: This study provided up-to-date information in terms of biochemical progression on the natural history of PHPT patients. No significant differences emerged between anti-resorptive therapy and observation only. It is not yet possible to assess the effect of pharmacological treatments on QoL in statistical terms. (Endokrynol Pol 2014; 65 (6): 456–463)
Abstract
Introduction: Primary hyperparathyroidism (PHPT) is an increasingly common endocrine disorder. Most patients with PHPT do not have disease-specific symptoms. The management of these patients has been widely debated. Recent studies have shown the importance of following up asymptomatic patients in order to reduce co-morbidity. However, there are conflicting opinions as to medical management. The aim of our study was to compare the outcome of PHPT patients on antiresorptive therapy vs. observation only.
Material and methods: We longitudinally evaluated 157 PHPT patients (126 females) aged 22–90 years. Patients who did not undergo surgery were divided into two groups: those on anti-resorptive therapy (N = 52), and those without any treatment (N = 37). Patients who were disease-free after surgery (N = 50) served as controls.
Results: The values of serum calcium (S-Ca), parathyroid hormone (PTH) and indices of bone metabolism did not differ significantly among the three groups of subjects. No differences in 25(OH)-vitamin D levels were noted. Bone mineral density (BMD) was not significantly different at the spinal level. Finally, we found no evidence of an effect of medical treatment on quality of life (QoL). However, QoL significantly improved in the surgery group after parathyroidectomy (PTX).
Conclusions: This study provided up-to-date information in terms of biochemical progression on the natural history of PHPT patients. No significant differences emerged between anti-resorptive therapy and observation only. It is not yet possible to assess the effect of pharmacological treatments on QoL in statistical terms. (Endokrynol Pol 2014; 65 (6): 456–463)
Keywords
primary hyperparathyroidism; PHPT; medical treatment; clinical observation; longitudinal evaluation; parathyroidectomy
About this articleTitle
Five-year longitudinal evaluation of mild primary hyperparathyroidism — medical treatment versus clinical observation
Journal
Issue
Article type
Original paper
Pages
456-463
Published online
2014-12-31
Page views
1926
Article views/downloads
2185
DOI
10.5603/EP.2014.0063
Bibliographic record
Endokrynol Pol 2014;65(6):456-463.
Keywords
primary hyperparathyroidism
PHPT
medical treatment
clinical observation
longitudinal evaluation
parathyroidectomy
Authors
Lara Vera
Martina Accornero
Mara Dolcino
Silvia Oddo
Massimo Giusti
