Parathyroid Surgery in the Elderly

Morris, Lilah F.; Zelada, Juliette; Wu, Bian; Hahn, Theodore J.; Yeh, Michael W.

doi:10.1634/theoncologist.2010-0158

Cited by 30 publications

(12 citation statements)

References 63 publications

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“…4,[17][18][19] The safety of PTx in older adults was demonstrated in a retrospective study of 1,275 participants aged 65 and older, including 217 aged 80 and older. Reversible complications unrelated to PTx occurred in three younger and eight older participants.…”

Section: Discussionmentioning

confidence: 99%

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Surgical Management of Primary Hyperparathyroidism in Older Adults

Denizot¹,

Grino

Oliver³

2014

J American Geriatrics Society

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Section: Discussionmentioning

confidence: 99%

“…Excellent results have been reported in older adults, even in nonagenerians. 4,[17][18][19] The safety of PTx in older adults was demonstrated in a retrospective study of 1,275 participants aged 65 and older, including 217 aged 80 and older. 20 Moderately longer hospital and recovery room stays have been reported in older adults.…”

Section: Discussionmentioning

confidence: 99%

Surgical Management of Primary Hyperparathyroidism in Older Adults

Denizot¹,

Grino

Oliver³

2014

J American Geriatrics Society

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“…Since PHPT disproportionately affects the elderly, this overall incidence is likely to rise as the nation’s median population ages [2–4]. The prevalence rate among older women aged 65 to 74 years, a cohort already at elevated risk for disabling bone disease, is currently 99 per 100,000 [1, 4]. The disorder can have broad pathophysiologic effects, including nephrolithiasis, neurologic symptoms, and reduced bone density [2, 5].…”

Section: 1 Introductionmentioning

confidence: 99%

Impaired calcium sensing distinguishes primary hyperparathyroidism (PHPT) patients with low bone mineral density

et al. 2017

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Context A subset of PHPT patients exhibit a more severe disease phenotype characterized by bone loss, fractures, recurrent nephrolithiasis, and other dysfunctions, but the underlying reasons for this disparity in clinical presentation remain unknown. Objective We sought to identify new mechanistic indices that could inform more personalized management of PHPT. Design Pre-, peri-, and postoperative data and demographic, clinical, and pathological information from patients undergoing parathyroidectomy for PHPT were collected. Univariate and partial Spearman correlation was used to estimate the association of parathyroid tumor calcium sensing capacity with select variables. Patients or Other Participants An unselected series of 237 patients aged >18 years and undergoing parathyroidectomy for PHPT were enrolled. Main outcome measures Calcium sensing capacity, expressed as the concentration required for half-maximal biochemical response (EC50), was evaluated in parathyroid tumors from an unselected series of 74 patients and assessed for association with clinical parameters. The hypothesis was that greater disease severity would be associated with attenuated calcium sensitivity and biochemically autonomous parathyroid tumor behavior. Results Parathyroid tumors segregated into two distinct groups of calcium responsiveness (EC50 <3.0 and ≥3.0 mM). The low EC50 group (n=27) demonstrated a mean calcium EC50 value of 2.49 mM [95% confidence interval (CI): 2.43–2.54 mM], consistent with reference normal activity. In contrast, the high EC50 group (n=47) displayed attenuated calcium sensitivity with a mean EC50 value of 3.48 mM [95% CI: 3.41–3.55 mM]. Retrospective analysis of the clinical registry data suggested that high calcium EC50 patients presented with a more significant preoperative bone mineral density (BMD) deficit with a T-score of −2.7, (95% CI: −3.4 to −1.9) versus 0.9, (95% CI: −2.1 to −0.4) in low EC50 patients (p < 0.001). After adjusting for gender, age, BMI, 25 OH vitamin D level and preoperative iPTH, lowest T-score and calcium EC50 were inversely correlated, with a partial Spearman correlation coefficient of −0.35 (p=0.02). Conclusions Impaired calcium sensing in parathyroid tumors is selectively observed in a subset of patients with more severe bone mineral density deficit. Assessment of parathyroid tumor biochemical behavior may be a useful predictor of disease severity as measured by bone mineral density in patients with PHPT.

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“…В отдельных клинических случаях манифестация ПГПТ у пожилых пациентов сопровождается развитием деменции, которая нивелируется после ПТЭ. Как правило, КН преобладают у лиц старше 70 лет [12].…”

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Cognitive impairment in primary hyperparathyroidism

Mokrysheva

Krupinova

Bibik

et al. 2019

Nevrologiâ, nejropsihiatriâ, psihosomatika

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Когнитивные нарушения (КН) являются неклассическим проявлением первичного гиперпаратиреоза, связанного с нарушением фосфорно-кальциевого обмена. Патофизиологические механизмы когнитивной дисфункции при этом эндокринном заболевании до конца не выяснены. Тем не менее продемонстрировано улучшение нейропсихологического состояния и качества жизни пациентов на фоне достижения нормокальциемии и снижения уровня паратгормона после хирургического лечения гиперпаратиреоза. Для определения возможности использования психоневрологических осложнений в качестве показаний к паратиреоидэктомии необходимы дальнейшие крупные контролируемые исследования.

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Parathyroid Surgery in the Elderly

Cited by 30 publications

References 63 publications

Surgical Management of Primary Hyperparathyroidism in Older Adults

Surgical Management of Primary Hyperparathyroidism in Older Adults

Impaired calcium sensing distinguishes primary hyperparathyroidism (PHPT) patients with low bone mineral density

Cognitive impairment in primary hyperparathyroidism

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