Institute of Endocrinology, Diabetes and Metabolism, Rabin Medical Center, Petah-Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
Medicine F, Rabin Medical Center, Petah-Tikva, Israel.
Maturitas. 2020 May;135:47-52. doi: 10.1016/j.maturitas.2020.02.010. Epub 2020 Feb 29.
With the current aging of the world's population, primary hyperparathyroidism (PHPT) is increasingly detected in the elderly. Yet data on the presentation and outcome of PHPT in this group are scarce. The objective was to describe a cohort of patients aged 75 years or more with PHPT observed in our endocrine clinic.
A retrospective analysis of medical records in an endocrine clinic at a tertiary hospital. We evaluated 182 patients with PHPT, aged 75 years or more at their last follow-up, all diagnosed at age 65 or more. Laboratory data were compared at diagnosis and last follow-up.
Mean age at diagnosis was 73 ± 4 years, last follow-up was at 83 ± 4 years, and mean follow-up was 11.3 ± 5.5 years. Osteoporosis, fractures, and nephrolithiasis were diagnosed in 114(63 %), 84(46 %), and 43(24 %) patients, respectively. Overall, 150 patients had an indication for surgery; of them, the 29 who underwent parathyroidectomy were younger than the non-operated patients and had higher rates of hypercalciuria. During the follow-up of the 141 patients who did not undergo operation, serum and urinary calcium levels significantly had decreased, and vitamin D level had increased at last visit (10.4 ± 0.5 mg/dl, 161 ± 70 mg/24 h, 69 ± 17 nmol/l, p < 0.01 respectively) compared with levels at diagnosis (10.6 ± 0.2 mg/dl, 223 ± 95 mg/24 h, 53 ± 15 nmol/l, respectively, p = 0.001). Overall, 38 of the 182 patients (20 %) died during follow-up; these patients were significantly older at diagnosis (76 ± 5 vs. 72 ± 4 years) but there were no differences in laboratory variables.
While most patients had a formal indication for surgery, few underwent parathyroidectomy. Serum and urinary calcium significantly decreased during follow-up in patients who did not undergo surgery. Our data are reassuring and support at least the consideration of conservative treatment for these patients.
随着世界人口老龄化，原发性甲状旁腺功能亢进症（PHPT）在老年人中越来越常见。然而，关于这一人群中 PHPT 的表现和结局的数据很少。本研究旨在描述我们内分泌科观察到的一组年龄在 75 岁及以上的 PHPT 患者。
对一家三级医院内分泌科的病历进行回顾性分析。我们评估了 182 名年龄在 75 岁及以上的 PHPT 患者，他们在最后一次随访时的年龄均为 65 岁或以上。比较了诊断时和最后一次随访时的实验室数据。
诊断时的平均年龄为 73 ± 4 岁，最后一次随访时为 83 ± 4 岁，平均随访时间为 11.3 ± 5.5 年。114 例（63%）、84 例（46%）和 43 例（24%）患者分别诊断为骨质疏松症、骨折和肾结石。总体而言，150 例患者有手术指征；其中，29 例行甲状旁腺切除术的患者比未手术患者年轻，且高钙尿症发生率更高。在未行手术的 141 例患者的随访过程中，血清和尿钙水平在最后一次就诊时显著降低，维生素 D 水平升高（10.4 ± 0.5 mg/dl、161 ± 70 mg/24 h、69 ± 17 nmol/L，分别，p < 0.01）与诊断时相比（10.6 ± 0.2 mg/dl、223 ± 95 mg/24 h、53 ± 15 nmol/L，p = 0.001）。总体而言，182 例患者中有 38 例（20%）在随访期间死亡；这些患者的诊断年龄明显较大（76 ± 5 岁比 72 ± 4 岁），但实验室指标无差异。
尽管大多数患者有手术的明确指征，但只有少数患者行甲状旁腺切除术。未行手术的患者在随访过程中血清和尿钙显著降低。我们的数据令人安心，并支持至少对这些患者进行保守治疗的考虑。
