The natural history of treated and untreated primary hyperparathyroidism: the Parathyroid Epidemiology and Audit Research Study

N. Yu, G. P. Leese, D. Smith, P. T. Donnan

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    Abstract

    Aim: To provide an update on the natural history of treated and untreated PHPT.

    Design: Retrospective population-based observational study.

    Methods: From 1997 to 2006, a well-defined cohort of PHPT patients was established in Tayside, Scotland. Subsequent cohorts of 'mild untreated' and 'surgically treated' PHPT patients were selected for the present study. Their serum calcium (S-Ca) and PTH concentrations were followed until September 2009. Surgical outcomes were evaluated using hospital admission data.

    Results: A total of 904 'mild untreated' patients were identified (median follow-up = 4.7 years), with a baseline median S-Ca of 2.62 mmol/l. A general decreased trend was observed in the S-Ca concentration for up to 12 years but an increasing trend in PTH (P < 0.001 in both instances). Disease progression, defined as an increase in S-Ca concentration, was observed in 121 patients (13.4%). Twenty-six (2.9%) patients had undergone surgery during the subsequent follow-up period. Baseline age and PTH concentration were the only significant risk factors for disease progression. In comparison, there were 200 'surgically treated' patients (median follow-up = 5.8 years). S-Ca was normalised after surgery, in 196 patients (98%). Hospital admissions for renal complications were reduced after surgery. In conclusion, most untreated patients with mild PHPT had no progression of S-Ca but approximately 15% did show some evidence of progression. Parathyroidectomy, with a high success rate, normalized the S-Ca in patients with PHPT.

    Original languageEnglish
    Pages (from-to)513-521
    Number of pages9
    JournalQJM : an International Journal of Medicine
    Volume104
    Issue number6
    DOIs
    Publication statusPublished - Jun 2011

    Keywords

    • ASYMPTOMATIC PRIMARY HYPERPARATHYROIDISM
    • 3RD INTERNATIONAL WORKSHOP
    • QUALITY-OF-LIFE
    • MILD PRIMARY HYPERPARATHYROIDISM
    • MEDICAL-MANAGEMENT
    • MEASURABLY IMPROVES
    • CLINICAL-TRIAL
    • SURGERY
    • STATEMENT
    • DIAGNOSIS

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