Rizk Youssef, Saad Nour, Arnaout Wassim, Chalah Moussa A, Farah Stephanie
Department of Internal Medicine, Division of Family Medicine, LAU Medical Center-Rizk Hospital, Gilbert and Rose Marie Chagoury School of Medicine, Lebanese American University, Beirut P.O. Box 13-5053, Lebanon.
Gilbert and Rose-Marie Chagoury School of Medicine, Lebanese American University, Byblos P.O. Box 13-5053, Lebanon.
J Clin Med. 2023 Sep 30;12(19):6321. doi: 10.3390/jcm12196321.
Primary hyperparathyroidism (PHPT) is a common endocrine disorder among older adults. The aim of this review is to shed light on PHPT, particularly in this age group, in terms of prevalence, clinical manifestations, medical and surgical management, and post-operative complications.
Eligible studies were those considering PHPT exclusively in the older population (main databases: PubMed, Medline, Google Scholar and the University Online database). Articles published in the last 10 years (2013-2023) were considered. Eligibility criteria followed the SPIDER (sample, phenomenon of interest, design, evaluation, research type) tool. The methodological quality of the studies was assessed using the Joanna Briggs Institute critical appraisal tool. A total of 29 studies (mainly observational) matched the inclusion criteria.
The prevalence of PHPT is approximately 1 per 100 in the elderly, and it is more common in females. The clinical presentation varies by age and can include osteoporosis, fractures, and neuropsychiatric symptoms. Conservative management can be an option whenever surgery is not indicated or feasible. However, parathyroidectomy (PTX) remains a safe and effective modality in aging populations with improvement to symptoms, bone mineral density, fracture risk, frailty, quality of life, and metabolic derangements. Complication rates are similar in elderly people compared to younger ones, except for mildly longer length of hospital stay and reoperation for those with higher frailty.
PHPT is a common yet overlooked and underdiagnosed condition among the older population. The safety and efficacy of PTX in the older population on different levels is now well demonstrated in the literature.
原发性甲状旁腺功能亢进症（PHPT）是老年人中常见的内分泌疾病。本综述旨在从患病率、临床表现、药物和手术治疗以及术后并发症等方面，阐明PHPT，尤其是在该年龄组中的情况。
符合条件的研究是那些专门针对老年人群体的PHPT研究（主要数据库：PubMed、Medline、谷歌学术和大学在线数据库）。考虑了过去10年（2013 - 2023年）发表的文章。纳入标准遵循SPIDER（样本、感兴趣的现象、设计、评估、研究类型）工具。使用乔安娜·布里格斯研究所的批判性评价工具评估研究的方法学质量。共有29项研究（主要是观察性研究）符合纳入标准。
老年人中PHPT的患病率约为每100人中有1例，且在女性中更为常见。临床表现因年龄而异，可包括骨质疏松症、骨折和神经精神症状。当手术不适用或不可行时，保守治疗可以是一种选择。然而，甲状旁腺切除术（PTX）在老年人群体中仍然是一种安全有效的治疗方式，可改善症状、骨矿物质密度、骨折风险、虚弱状况、生活质量和代谢紊乱。与年轻人相比，老年人的并发症发生率相似，只是身体较为虚弱者的住院时间略长，再次手术的情况较多。
PHPT在老年人群体中是一种常见但被忽视和诊断不足的疾病。目前文献已充分证明PTX在老年人群体不同层面上的安全性和有效性。
