Sporadic primary hyperparathyroidism in young individuals: different disease and treatment?

Autor: Sneider MS; DeWitt Daughtry Family Department of Surgery, Division of Endocrine Surgery, University of Miami, Leonard M. Miller School of Medicine, Miami, Florida 33136, USA., Solorzano CC, Montano RE, Anello C, Irvin GL 3rd, Lew JI
Jazyk: angličtina
Zdroj: The Journal of surgical research [J Surg Res] 2009 Jul; Vol. 155 (1), pp. 100-3. Date of Electronic Publication: 2008 Sep 04.
DOI: 10.1016/j.jss.2008.07.041
Abstrakt: Background: Younger individuals with hyperparathyroidism may experience severe disease with a higher incidence of multigland disease (MGD) and operative failure, thereby requiring subtotal parathyroidectomy. This study examines the characteristics and surgical outcome of younger compared with older patients with sporadic primary hyperparathyroidism (SPHPT).
Methods: Prospectively collected data of 1101 patients with SPHPT who underwent parathyroidectomy at a single institution were retrospectively reviewed. Patients with multiple endocrine neoplasia (MEN), familial, secondary, or tertiary hyperparathyroidism, parathyroid carcinoma, rickets, or lithium induced disease were excluded. Patients were subdivided into two groups: (1) younger individuals < or = 40 y of age (n = 110) and (2) older individuals > 40 y of age (n = 991). Both age groups were compared for gender, clinical manifestations, pre- and postoperative laboratory values, MGD, operative success, and recurrent disease.
Results: There was greater male predominance in younger compared with older patients treated for SPHPT (41% versus 25%, P = 0.0004). Of the clinical manifestations of SPHPT, kidney stones were more common in younger compared with older individuals (45% versus 29%, P = 0.0006). Conversely, bone pain was more common in older compared with younger patients (32% versus 14%, P = 0.0002). There was no statistical difference in biochemical values, MGD, and outcome between both groups.
Conclusions: Despite male predominance and few differences in symptoms, SPHPT is a similar disease entity in both younger and older individuals. Patients from both age groups can be similarly treated for SPHPT with a high rate of operative success. Routine BNE and subtotal parathyroidectomy is not necessary in younger individuals.
Databáze: MEDLINE
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