Context:It is unclear whether patients with asymptomatic primary hyperparathyroidism (PHPT) do better with parathyroidectomy (PTx) as compared with conservative medical management.
Objective:The aim of the study was to evaluate the beneficial effect of PTx vs. conservative management in patients with mild asymptomatic PHPT.
Design:We conducted a prospective, randomized study.
Setting:The study took place at a referral center.
Patients:We studied 50 patients who did not meet any guidelines for parathyroid surgery as recommended by the National Institutes of Health Consensus Development Conference on Asymptomatic PHPT.Intervention: Patients were randomly assigned to PTx or no PTx and were evaluated at 6 months and at 1 yr.
Main Outcome Measures:We compared changes (percentage of basal) of lumbar spine bone mineral density (BMD) between the two groups at 1 yr.
Results:The change in BMD at lumbar spine was greater after PTx (ϩ4.16 Ϯ 1.13 for PTx vs. Ϫ1.12 Ϯ 0.71 for no PTx; P ϭ 0.0002). The change in BMD at the total hip was also significantly greater in the PTx group (ϩ2.61 Ϯ 0.71 for PTx vs. Ϫ1.88 Ϯ 0.60 for no PTx; P ϭ 0.0001). There was no difference in BMD after 1 yr between both groups at the one-third radius site. In comparison with those who did not undergo surgery, the PTx subjects, after 1 yr, showed significant differences in four quality of life measures as determined by the 36-item short form health survey scale: bodily pain (P ϭ 0.001), general health (P ϭ 0.008), vitality (P ϭ 0.003), and mental health (P ϭ 0.017).
Conclusions:In patients with mild asymptomatic PHPT, successful PTx is followed by an improvement in BMD and quality of life.
VF rate is increased in postmenopausal women with PHPT compared to controls, independently of whether they are classified as symptomatic or asymptomatic. The question of whether the finding of mild morphometric VFs in the latter represents an indication for parathyroid surgery remains to be established.
The purpose of the study was to evaluate the relationship between serum 25(OH)D and the clinical phenotype in 215 consecutive Italian Caucasian women with sporadic primary hyperparathyroidism (PHPT) not taking vitamin D supplements. The study was performed at a single Italian tertiary center. PHPT-related manifestations, serum 25(OH)D, and other parameters of calcium metabolism and bone mineral density (BMD) by DXA were recorded. Serum 25(OH)D was negatively correlated with age (r = -0.18; P = 0.006), BMI (r = -0.20; P = 0.002), PTH (r = -0.21; P = 0.001), bone-specific alkaline phosphatase (BSAP) (r = -0.27; P < 0.001), and eGFR (r = -0.22; P = 0.01), and positively with serum creatinine and 1/3 distal radius BMD (R-BMD; r = 0.17; P = 0.015). In a multivariate regression analysis, serum 25(OH)D remained significantly correlated with age (r = -0.18; P = 0.005), BMI (r = -0.23; P = 0.049), serum PTH (r = -0.01; P = 0.023), BSAP (r = -0.01; P = 0.023) and eGFR (r = -0.09; P = 0.001), but not with R-BMD. Serum 25(OHD) was higher in patients with nephrolithiasis than in those without nephrolithiasis (18.5 ± 8.8 vs. 15.6 ± 8.0 ng/ml; P = 0.029), whereas no difference was found between fractured and unfractured patients (16.8 ± 9.3 vs. 16.0 ± 7.7; P = 0.663). There was a statistically significant inverse correlation between vitamin D status [defined by quartiles of measured values as well as commonly accepted cutoffs of serum 25(OH)D] and severity of the disease, as reflected by higher PTH and BSAP, but not by meeting the latest guidelines for parathyroidectomy. In conclusion, a low vitamin D status is associated with some features reflecting a more severe biochemical and clinical phenotype of PHPT in Italian women not taking vitamin D supplements.
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