Underutilization of Parathyroidectomy in Elderly Patients with Primary Hyperparathyroidism

Abstract

PHPT is undertreated in the elderly. We observed a progressive age-related decline in PTx rate that renders patients aged 70+ unlikely to have definitive treatment, irrespective of comorbidity and eligibility for surgery.

Renal stones and calcifications in patients with primary hyperparathyroidism: associations with biochemical variables

“…However, the precise relationship between the clinical presentation of PHPT and the increased formation of renal stones is not completely understood as only some (20), but not all (19,21) studies have shown an increased renal calcium excretion in PHPT patients with renal stones. Young age at the time of diagnosis (17,20,21,22,23,24) and male gender (17,20,23,25) have often been associated with renal stones, whereas divergent results have been reported for other variables including parathyroid pathology (17,21,22,23,26,27), plasma calcium (17,20,21,22,23,27), plasma PTH (17,20,22,27), plasma calcitriol (13,17,27), diuresis (17,26) and other biochemical variables such as urinary citrate (17,26). To prevent stone formation in the urinary tract, there are inhibitors and among these citrate is the most important.…”

Parathyroidectomy in the Elderly: Analysis of 7313 Patients

“…It is a disease primarily of the elderly; its incidence increases with age, such that it affects more than 1.5% of Americans over 65 y [2][3][4]. Surgery is the treatment of choice, as it represents the only potential for cure [5][6][7]. Wu et al recently reported underutilization of parathyroidectomy in the aging population, with only about 25% of parathyroidectomies in the U.S. being performed in elderly patients [7].…”

“…Surgery is the treatment of choice, as it represents the only potential for cure [5][6][7]. Wu et al recently reported underutilization of parathyroidectomy in the aging population, with only about 25% of parathyroidectomies in the U.S. being performed in elderly patients [7].…”

Predicting the Effect of Parathyroidectomy on Patient Survival in Secondary Hyperparathyroidism with Machine Learning

“…Several studies have found that parathyroidectomy is underutilized [12], and the under treatment seems to hinge on at least 2 factors: first, a lack of diagnostic awareness, and second, deferment of evaluation [13], [14]. The informatics tools reported here can prompt timely referral for further evaluation and treatment.…”