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

TY - JOUR

T1 - The natural history of treated and untreated primary hyperparathyroidism

T2 - the Parathyroid Epidemiology and Audit Research Study

AU - Yu, N.

AU - Leese, G. P.

AU - Smith, D.

AU - Donnan, P. T.

PY - 2011/6

Y1 - 2011/6

N2 - 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.

AB - 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.

KW - ASYMPTOMATIC PRIMARY HYPERPARATHYROIDISM

KW - 3RD INTERNATIONAL WORKSHOP

KW - QUALITY-OF-LIFE

KW - MILD PRIMARY HYPERPARATHYROIDISM

KW - MEDICAL-MANAGEMENT

KW - MEASURABLY IMPROVES

KW - CLINICAL-TRIAL

KW - SURGERY

KW - STATEMENT

KW - DIAGNOSIS

U2 - 10.1093/qjmed/hcq261

DO - 10.1093/qjmed/hcq261

M3 - Article

C2 - 21266486

SN - 1460-2725

VL - 104

SP - 513

EP - 521

JO - QJM : an International Journal of Medicine

JF - QJM : an International Journal of Medicine

IS - 6

ER -