Physiology and Diseases of the Parathyroid Glands in the Elderly
| Autor: | Karyne Vinales, Álvaro Larrad-Jiménez, Antonio Ruiz-Torres, Emiliano Corpas, Ricardo Correa |
|---|---|
| Rok vydání: | 2021 |
| Předmět: |
Parathyroidectomy
medicine.medical_specialty endocrine system diseases medicine.diagnostic_test Calcitriol Medical treatment business.industry medicine.medical_treatment Normal aging Scintigraphy medicine.disease Gastroenterology Hypoparathyroidism Internal medicine medicine Hypercalciuria business Primary hyperparathyroidism medicine.drug |
| DOI: | 10.1016/b978-0-12-819667-0.00003-2 |
| Popis: | The calcium (Ca) balance decreases with aging. The skeletal mass increases until growth is completed and then decreases at a constant rate with age. Decreased vitamin D and increased PTH production with age likely contribute to these changes. Hypoparathyroidism (HP) in older patients is uncommon, secondary to neck surgery in most cases, and neuromuscular and psychiatric manifestations of hypocalcemia are predominant. The diagnosis is based on an inappropriately low serum PTH in the presence of hypocalcemia. The major causes and treatments of acute hypocalcemia are detailed. The treatment of chronic hypocalcemia with Ca and calcitriol is described. The goals of therapy are to avoid hypocalcemia, hyperphosfatemia, and hypercalciuria. Replacement of HP with rhPTH is also reviewed. Clinical management of hypercalcemia in the elderly is examined. Primary hyperparathyroidism (PHPT) is more frequent than HP and its prevalence increases with age. Clinical presentations mimic normal aging. Diagnosis is usually incidental and detected by mild hypercalcemia. Serum PTH may present diagnostic uncertainties in the elderly due to the lack of standardized values by age groups, with proven normal serum levels of 25(OH)D. Both the progression of hypercalcemia and the systemic involvement of PHPT appear to be lower in older patients compared to younger ones. The surgical criteria of PHPT are summarized. A parathyroidectomy should be considered in all patients with PHPT, regardless of age, to reduce the fracture risk. Ultrasound and scintigraphy with 99mTc-sestamibi (with four-dimensional computerized tomography if needed) allow performing a minimally invasive parathyroidectomy (MIP) in most patients. Other surgical approaches are also described. A cure rate of more than 95% has been reported in elderly patients after a parathyroidectomy, with very low rates of complications and no mortality. The chapter also reviews the postoperative follow-up, medical treatment, and follow-up in nonsurgical patients as well as the so-called Normocalcemic PHPT. |
| Databáze: | OpenAIRE |
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