Patient-based surgical outcome tool demonstrating alleviation of symptoms following parathyroidectomy in patients with primary hyperparathyroidism
ABSTRACT This study assessed the impact of parathyroidectomy on the preoperative symptoms of patients with primary hyperparathyroidism (1 degrees HPT) using a surgical outcome tool designed specifically for HPT. The multicenter nature of this study allowed us to validate further this disease-specific outcome tool. 1 degrees HPT patients from Canada, the United States, and Australia filled out the questionnaire preoperatively and postoperatively on day 7 and at 3 and 12 months. The symptoms recorded by the patients were expressed as parathyroidectomy assessment of symptoms (PAS) scores: the higher the score, the more symptomatic is the patient. Quality of Life (QOL) and self-rated health uni-scales were included. Altogether, 203 patients with 1 degrees HPT were enrolled; 27 from center A, 54 from center B, and 122 from center C; 58 nontoxic thyroid patients were enrolled for comparison. The comparison group had no significant change in their PAS scores throughout the study (scores 184, 215, 156, 186). All three centers demonstrated a significant reduction in symptoms following surgery. The median preoperative PAS score from center B patients was 282. Following surgery, PAS scores decreased significantly: 136, 58, 0 (p <0.05). Center C patients had a median preoperative PAS score of 344, decreasing postoperatively to 228 (p <0.05) and continuing to decrease to 190, then 180. Center A also demonstrated a significant reduction in symptoms at 3 months, from 510 preoperatively to 209 (p <0.001). Both QOL and self-rated health improved in the HPT patients, whereas no change was found in the comparison group following surgery. PAS scores are a reliable, disease-specific measure of symptoms seen with HPT. Parathyroidectomy significantly reduces these preoperative symptoms, and this change translated into an improved health-related QOL for the patients.
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ABSTRACT: SUMMARY Background: A growing number of patients with primary hyperpara- thyroidism (PHPT) are diagnosed in the absence of symptoms following routine biochemical screening. However, in some countries, overt manifestations and osteitis fibrosa cystica (OFC) still dominate the clinical profile of PHPT patients. Methods: We retrospectively studied clinical and biochemical manifestations of 47 consecutive patients with primary hyperpara- thyroidism who were treated with parathyroidectomy from October 1993 to June 2005. Results: Mean age was of 51.3 years. Our sample included 40 women (85%) and 7 men (15%). Seventy eight percent of cases had radiological features of OFC, namely subperiosteal bone resorption, cortical cysts and osteopenia. Pathological fracture occurred in nine patients (19.1%). Fifteen (32%) patients had clinically evident bony deformities or brown tumors mostly located in the mandible and maxilla. Conclusions: Our results indicate that symptomatic osteitis fibrosa cystica and severe decrease of bone mineral density were the primary manifestations of primary hyperparathyroidism. Most patients were referred to an oncology hospital for treatment due to a suspected malignant neoplasm. A comprehensive clinical evaluation with biochemical markers, imaging studies and histological results is needed to establish a possible diagnosis of primary hyperparathyroidism.
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ABSTRACT: Resumen Introducción: El hiperparatiroidismo primario (HPTP) es una enferme-dad frecuente. Se caracteriza por una secreción excesiva y autónoma de hormona paratiroidea (PTH) por una o más glándulas paratiroides. El HPTP se presenta con hipercalcemia y concentraciones elevadas de PTH. Su incidencia es variable, siendo más frecuente en la mujer (3:1) en la menopausia. En las últimas décadas se ha incrementado el diagnós-tico del HPTP asintomático debido a las determinaciones automatizadas del calcio. La sintomatología está dada por las concentraciones de calcio, PTH y el tiempo de evolución de la enfermedad. El tratamiento defini-tivo del HPTP es quirúrgico. Es importante considerar los criterios qui-rúrgicos recomendados en pacientes asintomáticos. El éxito del trata-miento está en relación con el equipo quirúrgico especializado en cirugía de paratiroides. Material y métodos: Se revisaron los expedien-tes clínicos de los pacientes que recibieron tratamiento quirúrgico de enero de 1998 a diciembre del 2008 en nuestro centro, se obtuvieron los datos clínicos, de laboratorio, el hallazgo quirúrgico, diagnóstico histopatológico y los resultados postquirúrgicos. Resultados: Se inclu-yeron 145 pacientes con una edad promedio de 53.2 años (± 13), 25 hombres y 120 mujeres. La mayor frecuencia de HPTP se observó en pacientes entre los 40 y 69 años de edad. El calcio sérico promedio al momento del diagnóstico fue de 11.8 mg/dL (± 1.34) y la mediana de PTH de 316.5 pg/mL (50-4627 pg/mL). El hallazgo histopatológico fue de 110 adenomas (76.6%), 28 hiperplasias (19.3%) y 6 carcinomas (4.1 %). Se obtuvo curación con la primera intervención en 138 pacientes (95.2%). Conclusiones: El HPTP es una enfermedad curable quirúrgicamente, es necesario corroborar el diagnóstico y en caso de ser asintomático el tratamiento quirúrgico debe valorarse de acuerdo a las características clínicas y los criterios recomendados. Abstract Introduction: Primary hyperparathyroidism (PHPT) is a common endo-crine disorder. It is characterized by chronic and excessive secretion of parathyroid hormone (PTH) originating from one or more parathyroid glands. The PHPT is associated with hypercalcemia and elevated levels of PTH. The incidence is variable and it is more frequent in post menopausic women (3:1). In the last decades the diagnosis of asymptomatic PHPT has increased since the introduction of automatized determinations of serum calcium . The symptomatology is related with the levels of cal-cium and PTH as well as the duration of the disease. Surgery is the primary option in treatment. It is important to assess the surgical criteria in asymptomatic patients. The successful treatment of this disease de-pends on a highly specialized team of parathyroid surgeons. Material and methods: We reviewed the clinical and biochemical background of patients that were subject to parathyroidectomy from January 1998 to December 2009 in our medical center. We analyzed the clinical and laboratory data, the final histopathologic diagnosis, and the surgery outcome. Results: 145 patients were included, with an average age of 53.2 years (± 13), including 25 men and 120 women. The greatest frequency of PHPT was observed in patients between 40 and 69 years of age. The average calcium level at diagnosis was 11.8 mg/dL (± 1.34) and the level of PTH was of 316.5 (50-4627 pg/mL). The histopathology diagnosis was: adenoma in 110 (76.6%), hyperplasia in 28 (19.3 %) and carcinoma in 6 (4.1%) patients. The disease was considered to be cured in 138 patients (95.2%) after the first surgery. Conclusions: PHPT is a surgically curable disease, it is necessary to confirm the diagnosis and decide the surgical treatment in accordance with the established criteria even if the disease is asymptomatic.