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Should 'Mild Primary Hyperparathyroidism' be reclassified as 'insidious'

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Should 'Mild Primary Hyperparathyroidism' be reclassified as 'insidious' : is it time to reconsider?. / Macfarlane, David P.; Yu, Ning; Donnan, Peter T.; Leese, Graham P.

In: Clinical Endocrinology, Vol. 75, No. 6, 2011, p. 730-737.

Research output: Contribution to journalArticle

Harvard

Macfarlane, DP, Yu, N, Donnan, PT & Leese, GP 2011, 'Should 'Mild Primary Hyperparathyroidism' be reclassified as 'insidious': is it time to reconsider?' Clinical Endocrinology, vol 75, no. 6, pp. 730-737., 10.1111/j.1365-2265.2011.04201.x

APA

Macfarlane, D. P., Yu, N., Donnan, P. T., & Leese, G. P. (2011). Should 'Mild Primary Hyperparathyroidism' be reclassified as 'insidious': is it time to reconsider?. Clinical Endocrinology, 75(6), 730-737. 10.1111/j.1365-2265.2011.04201.x

Vancouver

Macfarlane DP, Yu N, Donnan PT, Leese GP. Should 'Mild Primary Hyperparathyroidism' be reclassified as 'insidious': is it time to reconsider?. Clinical Endocrinology. 2011;75(6):730-737. Available from: 10.1111/j.1365-2265.2011.04201.x

Author

Macfarlane, David P.; Yu, Ning; Donnan, Peter T.; Leese, Graham P. / Should 'Mild Primary Hyperparathyroidism' be reclassified as 'insidious' : is it time to reconsider?.

In: Clinical Endocrinology, Vol. 75, No. 6, 2011, p. 730-737.

Research output: Contribution to journalArticle

Bibtex - Download

@article{7da31193af3f492bb606a4c6ef134d44,
title = "Should 'Mild Primary Hyperparathyroidism' be reclassified as 'insidious': is it time to reconsider?",
keywords = "ASYMPTOMATIC PRIMARY HYPERPARATHYROIDISM, CARDIOVASCULAR RISK-FACTORS, BONE-MINERAL DENSITY, UNTREATED PRIMARY HYPERPARATHYROIDISM, NATIONWIDE COHORT ANALYSIS, PARATHYROID SURGERY, SERUM-CALCIUM, FOLLOW-UP, POSTMENOPAUSAL WOMEN, AUDIT RESEARCH",
author = "Macfarlane, {David P.} and Ning Yu and Donnan, {Peter T.} and Leese, {Graham P.}",
note = "© 2011 Blackwell Publishing Ltd.",
year = "2011",
doi = "10.1111/j.1365-2265.2011.04201.x",
volume = "75",
number = "6",
pages = "730--737",
journal = "Clinical Endocrinology",
issn = "0300-0664",

}

RIS (suitable for import to EndNote) - Download

TY - JOUR

T1 - Should 'Mild Primary Hyperparathyroidism' be reclassified as 'insidious'

T2 - is it time to reconsider?

A1 - Macfarlane,David P.

A1 - Yu,Ning

A1 - Donnan,Peter T.

A1 - Leese,Graham P.

AU - Macfarlane,David P.

AU - Yu,Ning

AU - Donnan,Peter T.

AU - Leese,Graham P.

PY - 2011

Y1 - 2011

N2 - <p>Primary hyperparathyroidism (PHPT) is a common incidental finding on routine biochemical testing, affecting around 1% of the population. The majority of individuals will be asymptomatic at diagnosis, with no evidence of end organ damage, and unless individuals aged &lt; 50 years at diagnosis, they are often considered to have 'mild' PHPT, as they do not meet published criteria for parathyroidectomy (PTX). However, there is increasing evidence that 'mild' PHPT is associated with adverse health outcomes. Longterm observational studies describing the natural history of 'mild' PHPT suggest that even though biochemistry may be relatively stable in the majority, bone mineral density (BMD) does decline after approximately 10 years of observation, whereas significant improvements in BMD are seen following PTX. Recent large European record linkage studies of 'mild PHPT' demonstrate significantly increased all-cause and cardiovascular mortality, similar to rates published for patients with PHPT who meet the NIH surgical criteria. 'Mild' PHPT was also associated with increased admissions for nonfatal cardiovascular disease, renal failure, renal stones, fractures, hypertension, psychiatric disease, cancer and diabetes, suggesting that 'insidious' PHPT may be a more appropriate description, or at least that the term 'mild' should be abandoned. Randomized controlled trials (RCTs) have begun to explore the benefits of PTX in this condition, demonstrating improvements in BMD and some psychiatric outcomes at approximately 2 years of follow-up. However, larger, adequately powered, long-term, RCTs will be required to determine whether PTX improves potential long-term morbidity and mortality in patients with PHPT who do not meet standard surgical criteria.</p>

AB - <p>Primary hyperparathyroidism (PHPT) is a common incidental finding on routine biochemical testing, affecting around 1% of the population. The majority of individuals will be asymptomatic at diagnosis, with no evidence of end organ damage, and unless individuals aged &lt; 50 years at diagnosis, they are often considered to have 'mild' PHPT, as they do not meet published criteria for parathyroidectomy (PTX). However, there is increasing evidence that 'mild' PHPT is associated with adverse health outcomes. Longterm observational studies describing the natural history of 'mild' PHPT suggest that even though biochemistry may be relatively stable in the majority, bone mineral density (BMD) does decline after approximately 10 years of observation, whereas significant improvements in BMD are seen following PTX. Recent large European record linkage studies of 'mild PHPT' demonstrate significantly increased all-cause and cardiovascular mortality, similar to rates published for patients with PHPT who meet the NIH surgical criteria. 'Mild' PHPT was also associated with increased admissions for nonfatal cardiovascular disease, renal failure, renal stones, fractures, hypertension, psychiatric disease, cancer and diabetes, suggesting that 'insidious' PHPT may be a more appropriate description, or at least that the term 'mild' should be abandoned. Randomized controlled trials (RCTs) have begun to explore the benefits of PTX in this condition, demonstrating improvements in BMD and some psychiatric outcomes at approximately 2 years of follow-up. However, larger, adequately powered, long-term, RCTs will be required to determine whether PTX improves potential long-term morbidity and mortality in patients with PHPT who do not meet standard surgical criteria.</p>

KW - ASYMPTOMATIC PRIMARY HYPERPARATHYROIDISM

KW - CARDIOVASCULAR RISK-FACTORS

KW - BONE-MINERAL DENSITY

KW - UNTREATED PRIMARY HYPERPARATHYROIDISM

KW - NATIONWIDE COHORT ANALYSIS

KW - PARATHYROID SURGERY

KW - SERUM-CALCIUM

KW - FOLLOW-UP

KW - POSTMENOPAUSAL WOMEN

KW - AUDIT RESEARCH

U2 - 10.1111/j.1365-2265.2011.04201.x

DO - 10.1111/j.1365-2265.2011.04201.x

M1 - Article

JO - Clinical Endocrinology

JF - Clinical Endocrinology

SN - 0300-0664

IS - 6

VL - 75

SP - 730

EP - 737

ER -

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