Hyperparathyroidism in the Elderly Patient

Abstract

Primary hyperparathyroidism is a common metabolic bone disease and currently presents a significant management dilemma. Most of the patients have few relevant symptoms and surgical parathyroidectomy offers the prospect of cure with freedom from the risk of long-term complications or the need for a follow-up. However, there is a natural reluctance to subject elderly patients to an operation where the balance of advantage is less clear. Advances in parathyroid imaging resulting in a greater use of targeted or focused parathyroidectomy has opened the way for the inclusion of less fit patients into the potentially operable category. However, there is still debate about whether these newer imaging techniques are sufficiently helpful and cost effective to warrant their use in all patients who may need parathyroid surgery. This has stimulated a debate about the indications for parathyroidectomy in the elderly and whether advances in medical therapy, which offset the end organ effects of excess parathyroid hormone, are of sufficient benefit to counteract this trend towards greater surgical intervention. These considerations mean that it is not possible to consider the merits of pharmacological therapy for primary hyperparathyroidism without reviewing the relative merits of minimally invasive and conventional surgery.

Clinical Presentation of Primary Hyperparathyroidism in Older Adults

“…Although age <50 years is one of the criteria for surgery indicated by the guidelines for asymptomatic PHPT [9, 19], owing to the natural history of disease in this age group [19], to date only a few studies have evaluated the effect of age on the clinical presentation of PHPT [7, 8, 20, 21]. Some studies of the clinical features of juvenile PHPT have been recently reported [20, 21].…”

“…Few data are available regarding the influence of aging on the clinical presentation of PHPT, in particular its effect on disease management for patients >65 years ( i.e., older adults) [7, 8]. We, thus, evaluated a large unselected series of sporadic PHPT, assessing the clinical features and the likelihood of meeting the surgical criteria recommended by current guidelines for older adults compared with younger adults.…”