Comparison of Medical Management versus Parathyroidectomy in Patients with Mild Primary Hyperparathyroidism: A Meta-Analysis.

Autor: Cironi KA; School of Medicine, Tulane University, New Orleans, LA 70112, USA., Issa PP; School of Medicine, Louisiana State University, New Orleans, LA 70112, USA., Albuck AL; School of Medicine, Tulane University, New Orleans, LA 70112, USA., McCarthy C; School of Medicine, Tulane University, New Orleans, LA 70112, USA., Rezvani L; School of Medicine, Tulane University, New Orleans, LA 70112, USA., Hussein M; School of Medicine, Tulane University, New Orleans, LA 70112, USA., Luo X; School of Medicine, Tulane University, New Orleans, LA 70112, USA., Shama M; School of Medicine, Tulane University, New Orleans, LA 70112, USA., Toraih E; School of Medicine, Tulane University, New Orleans, LA 70112, USA.; Genetics Unit, Department of Histology and Cell Biology, Faculty of Medicine, Suez Canal University, Ismailia 41511, Egypt., Kandil E; School of Medicine, Tulane University, New Orleans, LA 70112, USA.
Jazyk: angličtina
Zdroj: Cancers [Cancers (Basel)] 2023 Jun 07; Vol. 15 (12). Date of Electronic Publication: 2023 Jun 07.
DOI: 10.3390/cancers15123085
Abstrakt: Background: Parathyroidectomy is the definitive cure for patients with primary hyperparathyroidism (pHPT) and has an annual prevalence of 0.2-1% in the United States. Some patients with mild disease are medically managed effectively using calcium-lowering medications and drugs against complications such as osteoporosis; however, many maintain a persistently high calcium level that negatively impacts their skeletal, renal, and psychogenic systems over the long term. This meta-analysis aims to compare the outcomes of medical management versus parathyroidectomy in patients with mild pHPT.
Study Design: This meta-analysis was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines using PubMed, Embase, and Web of Science by two teams of investigators. Analysis was run using R packages.
Results: A total of 12 publications including seven randomized control, two prospective, and three retrospective trials with a total of 1346 patients were included for analysis. The average follow-up for all patients was 41 ± 23.8 months. Demographics, pre-treatment calcium, PTH, and bone mineral density (BMD) were similar between the medical ( N = 632) and surgical ( N = 714) cohorts. Post-treatment calcium and PTH levels were significantly higher in the medical cohort (10.46 vs. 9.39, p < 0.01), (106.14 vs. 43.25, p = 0.001), respectively. Interestingly, the post-treatment PTH in the medical cohort increased when compared to pre-treatment (83.84 to 106.14). Patients in the medical cohort had lower BMD in lumbar (0.48 g/cm 2 ; OR = 0.42, 95% CI = 0.21, 0.83), femoral (0.48; OR = 0.42, 95% CI = 0.29, 0.61), and hip (0.61; OR = 0.33, 95% CI = 0.13, 0.85). Incidences of fracture, nephrolithiasis, cardiovascular death, or overall mortality were not significantly different between the cohorts.
Conclusions: The present study is the most comprehensive meta-analysis on mild pHPT to date. Our findings reflect that parathyroidectomy is the superior option in the treatment of mild pHPT patients as opposed to medical management.
Databáze: MEDLINE
Externí odkaz:
Nepřihlášeným uživatelům se plný text nezobrazuje