Background
Guidelines for operative treatment of primary hyperparathyroidism include calcium
levels >1 mg/dL above normal. We sought to determine whether greater calcium concentrations
were associated with increased symptoms or disease severity.
Methods
A retrospective review of a prospectively maintained database of adults undergoing
parathyroidectomy for primary hyperparathyroidism, grouped according to greatest preoperative
calcium level: those patients with calcium concentrations between 10.0 and 11.0 mg/dL
and those with >11.0 mg/dL. We compared subjective symptoms and objective measures
of disease severity.
Results
The review included 20,081 adults who were split nearly evenly between calcium concentrations
between 10.0 and 11.0 (10,430, 51.9%) and those with >11.0 mg/dL (9,651, 48.1%). In
both groups, an absence of symptoms related to primary hyperparathyroidism was uncommon
(<5%). All subjective and objective measures of disease severity were nearly identical
with no significant differences (percentages for calcium concentrations between 10.0
and 11.0 and those with >11.0 mg/dL, respectively), including fatigue (72% for both
groups), heartburn (37% vs 34%), bone pain (50% vs 48%), sleep disturbances (68% vs
65%), osteoporosis (40% in both groups), kidney stones (21% vs 22%), chronic kidney
disease with glomerular filtration rate <60 (29% vs 32%), and hypertension (50% vs
53%).
Conclusion
Serum calcium concentrations of greater than or less than 11 mg/dL are unrelated to
symptoms and disease severity in primary hyperparathyroidism. There is no evidence
to support a serum calcium threshold in parathyroidectomy guidelines.
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to SurgeryAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- 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
- Guidelines for the management of asymptomatic primary hyperparathyroidism: summary statement from the Fourth International Workshop.J Clin Endocrinol Metab. 2014; 99: 3561-3569
- Diagnosis and management of asymptomatic primary hyperparathyroidism. NIH Consensus Statement. Oct 29–31, 1990.Consens Statement. 1990; 8: 1-18
- Current issues in the presentation of asymptomatic primary hyperparathyroidism: proceedings of the Fourth International Workshop.J Clin Endocrinol Metab. 2014; 99: 3580-3594
- Primary hyperparathyroidism. Incidence, morbidity, and potential economic impact in a community.N Eng J Med. 1980; 98: 1122-1129
- The natural history of primary hyperparathyroidism with or without parathyroid surgery after 15 years.J Clin Endocrinol Metab. 2008; 93: 3462-3470
- Summary statement from a workshop on asymptomatic primary hyperparathyroidism: a perspective for the 21st century.J Clin Endocrinol Metab. 2002; 87: 5353-5361
- Guidelines for the management of asymptomatic primary hyperparathyroidism: summary statement from the Third International Workshop.J Clin Endocrinol Metab. 2009; 94: 335-339
- Randomized controlled trial of surgery versus no surgery in patients with mild asymptomatic primary hyperparathyroidism.J Clin Endocrinol Metab. 2004; 89: 5415-5422
- Increased mortality and morbidity in mild primary hyperparathyroid patients. The Parathyroid Epidemiology and Audit Research Study (PEARS).Clin Endocrinol (Oxf). 2010; 73: 30-34
- Parathyroidectomy for hypercalcemic crisis: 40 years’ experience and long-term outcomes.Surgery. 2010; 148: 807-812
- A 10-year prospective study of primary hyperparathyroidism with or without parathyroid surgery.N Engl J Med. 1999; 341: 1249-1255
- Calcium, parathyroid hormone, and vitamin D in patients with primary hyperparathyroidism: normograms developed from 10,000 cases.Endocrine Practice. 2011; 17: 384-394
- Fatigue and chronic fatigue syndrome-like complaints in the general population.Eur J Public Health. 2010; 20: 251-257
- Insomnia: definition, prevalence, etiology, and consequences.J Clin Sleep Med. 2007; 3: S7-S10
- Surgery for ‘asymptomatic’ mild primary hyperparathyroidism improves some clinical symptoms postoperatively.Eur J Endocrinol. 2013; 169: 665-672
- The effects of serum calcium and parathyroid hormone changes on psychological and cognitive function in patients undergoing parathyroidectomy for primary hyperparathyroidism.Ann Surg. 2011; 253: 131-137
- Surgical cure of primary hyperparathyroidism ameliorates gastroesophageal reflux symptoms.World J Surg. 2015; 39: 706-712
- Improvement of sleep disturbance and insomnia following parathyroidectomy for primary hyperparathyroidism.World J Surg. 2014; 38: 542-548
- Fibromyalgia symptoms and medication requirements respond to parathyroidectomy.Surgery. 2014; 156: 1614-1620
- Primary hyperparathyroidism, cognition, and health-related quality of life.Ann Surg. 2005; 242: 642-650
- Profile of a clinical practice: thresholds for surgery and surgical outcomes for patients with primary hyperparathyroidism: a national survey of endocrine surgeons.J Clin Endocrinol Metab. 1998; 83: 2658-2665
- Safety of immediate discharge after parathyroidectomy: a prospective study of 3,000 consecutive patients.Endocr Pract. 2007; 13: 105-113
Article info
Publication history
Published online: November 15, 2016
Accepted:
September 22,
2016
Footnotes
The authors report no outside sources of financial support.
Identification
Copyright
© 2016 Elsevier Inc. All rights reserved.
