Surgery for Primary Hyperparathyroidism (pHPT) in Patients Older Than 65 Years Compared With Follow-up

Surgery for Primary Hyperparathyroidism (pHPT) in Patients Older Than 65 Years Compared With Follow-up

Primary Hyperparathyroidism in Patients Older Than 65 Years: A Prospective Randomized Trial of Surgical Treatment Compared With Follow-up

General consensus and contemporary guidelines, recommend surgery for primary hyperparathyroidism (pHPT)for all patients below the age of 50, for patients with pronounced hypercalcemia and for patients with organ complications to the disease (osteoporosis and decreased renal function). The purpose of this study is to determine if surgery for pHPT, is appropriate for patients with moderate to mild hypercalcemia older than 65 years of age. The hypothesis of the study is that surgery for pHPT in patients older than 65 years of age, and with mild hypercalcemia, will increase bone density and hence decrease future risk for fragility fractures compared to patients with follow-up only.

The majority of patients diagnosed and operated due to primary HPT in Scandinavia are older than 65 years of age. The vast majority of the patients have mild aberrations of serum calcium (< 1.50 mmol/l ionized calcium), and some patients may even be asymptomatic. The present trial is designed to clarify the indications for surgical treatment in this large subgroup of patients.

Hyperparathyroidism, primary, Aged 66 years or older, Mild hypercalcaemia, Surgical Procedures, Elective, Indication, Osteoporosis, Cognitive function, Atherosclerosis, Follow-up, Randomized trial

Patients diagnosed biochemically and clinically with primary hyperparathyroidism who are followed only

Patients diagnosed biochemically and clinically with primary hyperparathyroidism who are treated with parathyroid surgery

Parathyroid Surgery (regardless of surgical strategy; i.e., focused operation, unilateral- or bilateral neck exploration)

Triglyceride and cholesterol concentrations of whole serum and of the lipoprotein classes; low-density-lipoprotein (LDL), very-low-density-lipoprotein (VLDL) and high-density-lipoprotein (HDL).

Cardiac function assessed with echocardiography; Left ventricular ejection fraction (EF), Left ventricular end-diastolic diameter (LVDD), Left ventricular mass index (LVMI), Ratio between mitral peak velocity flow of the early filling wave and the atrial filling wave (E/A ratio).

Mini Mental State Examination test (MMSE), for cognitive function. A Quich Test (AQT), for cognitive speed

Oral glucose tolerance test (75 Gram), with measurement of blood glucose and insulin after 60, 120 and 180 min.

Inclusion Criteria: Primary Hyperparathyroidism No previous parathyroid surgery Sporadic disease Exclusion Criteria: Z-score of Bone density < -2.5 SD (regardless of site) Serum level of ionized calcium > 1.50 mmol/L Inability to understand given information or to comply with scheduled follow-up Symptoms of hypercalcaemia for which specific medical treatment has been prescribed