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Background. Diagnosis of primary hyperparathyroidism (PHPT) is increasingly suspected in elderly patients after the discovery of hypercalcemia by routine measurement of serum calcium levels. Surgery is commonly accepted as the optimal treatment of PHPT. We wanted to assess risk and results of neck exploration in elderly patients with PHPT.
Methods. We performed a retrospective study of the charts of 78 patients older than 75 years (mean age, 79.1 years) with PHPT who underwent neck exploration during a 15-year period.
Results. The most common presenting symptoms were neurologic and psychiatric disorders (47 patients). Preoperative localization investigations, performed in 72 patients, were successful in 42 of them (sensivity, 58%). Single adenoma, double adenomas, and hyperplasia were found in 74 patients (95%), three patients, and one patient, respectively. Overall postoperative mortality was 3.8% (three patients) with no death since 1984. Significant complications occurred in three patients (4%): one myocardial infarction, one pulmonary embolism, and one cerebral hemorrhage. Average length of postoperative hospital stay was 4 days. Among patients who could be followed up (65 cases with a mean follow-up of 3 years), 94% reported an improvement in their symptoms. This was especially marked for fatigue and intellectual function.
Conclusions. These data support a liberal approach regarding surgical treatment in elderly patients with PHPT.
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- Primary hyperparathyroidism: incidence, morbidity, and potential economic impact in a community.N Engl J Med. 1980; 302: 189-193
- Hyperparathyroidism in the elderly.Ann Surg. 1983; 197: 135-138
- Clinical and experimental advances in sporadic primary hyperparathyroidism.Acta Chir Scand. 1990; 156: 23-28
- Surgical treatment of primary hyperparathyroidism in the elderly patient.Isr J Med Sci. 1983; 19: 150-152
- Le nouveau visage clinique de l'hyperparathyroïdie primitive. Circonstances de diagnostic et caractères symptomatiques actuels: résultats d'une enquête multicentrique.Rev Rhumatisme. 1988; 55: 561-568
- Surgical treatment of primary hyperparathyroidism in elderly patients.Acta Chir Scand. 1987; 153: 175-178
- Psychiatric symptomatology in patients with primary hyperparathyroidism.Ups J Med Sci. 1986; 91: 77-88
- Expanding indications for early parathyroidectomy in the elderly female.Am J Surg. 1978; 136: 45-48
- Parathyroid imaging: comparison of high-resolution CT and high-resolution sonography.AJR. 1983; 141: 633-638
- Surgery for primary hyperparathyroidism: experience with 500 consecutive cases and evaluation of the role of surgery in the asymptomatic patient.Br J Surg. 1982; 69: 244-247
- Pre-operative localization in unilateral parathyroid surgery. A cost-benefit study on ultrasound, computed tomography and scintigraphy.Acta Chir Scand. 1990; 156: 29-35
- Localizing studies in patient with persistent or recurrent hyperparathyroidism.Surgery. 1987; 102: 917-925
- Diagnosis of recurrent hyperparathyroidism: comparison of MR to other imaging techniques.Am J Roentgenol. 1988; 150: 1027-1033
- Parathyroid adenomectomy under local anesthesia with intra-operative monitoring of UcAMP and/or 1-84 PTH.World J Surg. 1992; 16: 570-575
- Non surgical treatment of primary hyperparathyroidism with sonographically guided percutaneous injection of ethanol: results in a selected series of patients.Am J Roentgenol. 1990; 154: 1087-1090
- Angiographic ablation of parathyroid adenomas: lessons from 10 years experience.Radiology. 1987; 165: 601-609
- Parathyroid surgery in the aged.J Gerontol. 1981; 36: 573-575
- Hyperparathyroidism in the elderly.Am J Surg. 1980; 139: 581-583
Accepted: September 2, 1994
© 1995 Mosby-Year Book, Inc. Published by Elsevier Inc.