Surgical Management of Primary Hyperparathyroidism in Older Adults

Denizot, A.; Grino, Michel; Oliver, Charles A.

doi:10.1111/jgs.12968

Cited by 13 publications

(15 citation statements)

References 35 publications

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“…As a consequence, parathyroidectomy has become less commonly performed by general surgeons resulting in the gradual centralization of care to specialist multidisciplinary units with high volume . This focus has enabled the introduction of more ambulant surgical pathways, minimally invasive procedures and the capacity to offer surgery to a greater proportion of patients . The published outcomes following parathyroidectomy are also frequently derived from specialized units or the accumulation of results collected by survey .…”

Section: Introductionsupporting

confidence: 90%

“…A number of complex problems can arise during surgical management . Diagnosis and preoperative gland location require specialist input and imaging, intraoperative identification of parathyroid tissue may be difficult and patients frequently have comorbidities that contribute to surgical risk . As a consequence, parathyroidectomy has become less commonly performed by general surgeons resulting in the gradual centralization of care to specialist multidisciplinary units with high volume .…”

Section: Introductionmentioning

confidence: 99%

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Cervical re‐explorations and proxy survival following parathyroidectomy for primary hyperparathyroidism using Australian administrative data

Purkiss

Keegel

Vally

et al. 2019

ANZ Journal of Surgery

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Background: Administrative data may have utility in the impartial assessment of surgical outcomes and rare events. We have used a publicly available sample of the Australian pharmaceutical and health service provision (medical benefits scheme) databases to assess outcomes following parathyroidectomy for primary hyperparathyroidism (PHP). Methods: A cohort study using linked pharmaceutical and medical benefits schemes data was performed covering the period 1993-2014. Procedure codes identified participants undergoing parathyroidectomy for PHP and subsequent cervical re-exploration surgery (CRX), and the last service date used as a proxy for survival. Time to CRX and survival were modelled using Kaplan-Meier analysis. Demographic data and the era of parathyroid surgery were managed as covariates for Cox regression survival analyses. Results: A total of 2165 persons undergoing parathyroidectomy for PHP were identified. Median follow-up was 5.3 years (range 0.2-22). The annual number of parathyroidectomies for PHP increased gradually; 72 individuals underwent CRX (3.3%). The median time to CRX was 152 days (confidence interval 0-396) in 2000-2004 reducing to 47 days (confidence interval 15-78) for the period 2010-2014 (log-rank P = 0.027). The proportion of persons requiring CRX reduced over time from 6.1% in 1997 to 2.1% in 2012 (r 2 = 0.5817, P = 0.023). Overall median survival (24.6 years) was poorer when compared with age matched controls (log-rank P = 0.025) but was not associated with CRX or gender. Conclusion: Administrative data can be used for the assessment of surgical outcomes and may be useful for comparisons of surgical performance, and the appraisal of infrequent events. CRX rates following parathyroidectomy for PHP are improving in Australia.© 2019 Royal Australasian College of Surgeons ANZ J Surg 90 (2020) 872-876ANZJSurg.com

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Section: Introductionsupporting

confidence: 90%

Section: Introductionmentioning

confidence: 99%

Cervical re‐explorations and proxy survival following parathyroidectomy for primary hyperparathyroidism using Australian administrative data

Purkiss

Keegel

Vally

et al. 2019

ANZ Journal of Surgery

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“…Surgery is recommended in older individuals meeting criteria for PTx if they are medically stable with no contraindications for surgery and/or the benefits of surgery outweigh the risks [100]. Advancing age is associated with greater morbidity, intraoperative and post-operative complications, and higher mortality rates following PTx [101].…”

Section: Management and Treatmentmentioning

confidence: 99%

Primary hyperparathyroidism: review and recommendations on evaluation, diagnosis, and management. A Canadian and international consensus

et al. 2016

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The purpose of this review is to assess the most recent evidence in the management of primary hyperparathyroidism (PHPT) and provide updated recommendations for its evaluation, diagnosis and treatment. A Medline search of "Hyperparathyroidism. Primary" was conducted and the literature with the highest levels of evidence were reviewed and used to formulate recommendations. PHPT is a common endocrine disorder usually discovered by routine biochemical screening. PHPT is defined as hypercalcemia with increased or inappropriately normal plasma parathyroid hormone (PTH). It is most commonly seen after the age of 50 years, with women predominating by three to fourfold. In countries with routine multichannel screening, PHPT is identified earlier and may be asymptomatic. Where biochemical testing is not routine, PHPT is more likely to present with skeletal complications, or nephrolithiasis. Parathyroidectomy (PTx) is indicated for those with symptomatic disease. For asymptomatic patients, recent guidelines have recommended criteria for surgery, however PTx can also be considered in those who do not meet criteria, and prefer surgery. Non-surgical therapies are available when surgery is not appropriate. This review presents the current state of the art in the diagnosis and management of PHPT and updates the Canadian Position paper on PHPT. An overview of the impact of PHPT on the skeleton and other target organs is presented with international consensus. Differences in the international presentation of this condition are also summarized.

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“…The treatment decision on whether to proceed to surgery was relatively straightforward in our patient's case; she had relatively few comorbidities , her hyperparathyroidism had resulted in a calcium level that had the potential to be lifethreatening if not treated and parathyroidectomy represented a definitive surgical cure. A recent publication [14] supports such a decision, reporting that with the exception of a few cases with severe associated comorbidities, parathyroidectomy is safe and curative in an elderly population (aged over 75), and should also be considered as first-line choice for older adults with PHPT.…”

Section: Discussionmentioning

confidence: 99%

The Rise of Calcium and Control of its Fall

Higgins¹,

Casey²,

Tarmey³

2016

JCR

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Abstract:This case highlights an atypical presentation of primary hyperparathyroidism with significant life-threatening hypercalcemia in an 83 year old lady admitted with non-specific symptoms of malaise, dyspnoea and epigastric discomfort. On imaging she was subsequently discovered to have two distinct unexpected findings, a parathyroid mass and a cystic pancreatic mass. Initially an underlying genetic syndrome linking the two structural lesions was considered, possibly a pancreatic neuroendocrine tumor in the presence of a parathyroid mass. However further investigation with a CT pancreatic protocol, revealed her pancreas to show evidence of previous pancreatitis with resultant pseudocyst formation, likely all induced by hypercalcemia of unknown duration. She denied any prior acute episodes of epigastric pain. Whilst previous case reports describe the diagnosis of a parathyroid lesion presenting with acute pancreatitis, our case is rare in that the pancreatitis was an incidental discovery. Although relatively asymptomatic, the pancreatic inflammation induced by hypercalcaemia was significant resulting in development of a large pseudocyst in the pancreatic tail and radiological evidence consistent with previous episodes of pancreatitis. The patient's hypercalcemia had also resulted in nephrocalcinosis and tooth resorption. This case acts a reminder that although primary hyperparathyroidism is often considered a relatively benign entity, life-threatening hypercalcemia can develop and requires urgent management. It highlights the multi-systemic sequelae that can occur with chronic hypercalcemia and reminds us that parathyroid carcinoma although rare, must always be considered when markedly elevated levels of parathyroid hormone and hypercalcemia are encountered.

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Surgical Management of Primary Hyperparathyroidism in Older Adults

Abstract: With the exception of a few cases with severe associated comorbidities, parathyroidectomy is safe and curative and should be considered as first-line choice for older adult with PHPT.

Cited by 13 publications

References 35 publications

Cervical re‐explorations and proxy survival following parathyroidectomy for primary hyperparathyroidism using Australian administrative data

Cervical re‐explorations and proxy survival following parathyroidectomy for primary hyperparathyroidism using Australian administrative data

Primary hyperparathyroidism: review and recommendations on evaluation, diagnosis, and management. A Canadian and international consensus

The Rise of Calcium and Control of its Fall

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