Primary Hyperparathyroidism in Young Adults

Abstract

Our results suggest that the same treatment strategy should be applied to all patients with primary hyperparathyroidism. Ultrasound appears to be the localization procedure of choice in younger patients.

Does multiple gland disease in primary hyperparathyroidism correlate with age or sex?

“…Whereas up to five times more adult women are affected compared to adult men, the rate of male patients in the younger group is slightly higher. The amount of 39.6% male patients aged 40 years or younger (male/female ratio 1/1.5) compared to 18.9% in the older group (male/female ratio 1/4.3) resembles the results of other study groups [4,7,[15][16][17]. This effect was even more pronounced in paediatric PHPT patients, with nearly equal rates for boys and girls (Table 4) [3,5,6,8].…”

“…Analysing the data of 99 patients aged 16-39 years (23.2% MGD) and 609 patients aged 40-91 years (16.7% MGD), they came to the same conclusion that sporadic PHPT in young patients has "no increased risk for MGD" and "can be managed with a similar surgical approach" [15]. Also Joshua et al, who compared 33 PHPT patients aged 16-40 years with 286 PHPT patients aged 41-81 years (9.1% MGD in both groups), suggest "the same treatment strategy" for all PHPT patients [17].…”

“…Surgery, the only curative option for PHPT, could have been denied, and in some patients, PHPT has been treated conservatively for years. The hypotheses were raised that children with severe symptoms of hypercalcaemia might have been referred earlier to surgical treatment than asymptomatic adult PHPT patients, while men might have visited their physician later than women, despite symptoms [11,17].…”

Sporadic Primary Hyperparathyroidism in Young Individuals: Different Disease and Treatment?

“…These patients were then subdivided into two groups: (1) young individuals 40 y of age (n ¼ 110), and (2) older individuals >40 y of age (n ¼ 991). Prior reports have used different ages of reference for defining young individuals with HPT, ranging from 19 to 40 y [1][2][3][4][5]. For the purpose of this study, age 40 was chosen as the defined young age of reference.…”

“…Furthermore, the recommendation for routine bilateral neck explorations and extended or subtotal parathyroidectomy in all younger patients has been made with the assumption that there is a different form and severity of HPT in this population [4]. Conversely, other evidence suggests that this age-related disease association does not exist, and that patients of any age with HPT should be treated in a similar surgical fashion [5].…”