How asymptomatic is asymptomatic primary hyperparathyroidism?

Citation
C. Hasse et al., How asymptomatic is asymptomatic primary hyperparathyroidism?, EXP CL E D, 108(4), 2000, pp. 265-274
Citations number
39
Language
INGLESE
art.tipo
Article
Categorie Soggetti
Endocrinology, Nutrition & Metabolism
Journal title
EXPERIMENTAL AND CLINICAL ENDOCRINOLOGY & DIABETES
ISSN journal
0947-7349 → ACNP
Volume
108
Issue
4
Year of publication
2000
Pages
265 - 274
Database
ISI
SICI code
0947-7349(2000)108:4<265:HAIAPH>2.0.ZU;2-#
Abstract
We observed several cases of patients who believed they were free of sympto ms or signs of primary hyperparathyroidism (pHPT) preoperatively. reported a change of complaints following parathyroidectomy (PTX). We, therefore, de cided to examine a larger group of patients to discover if these findings w ere incidental or of more general significance. The role of PTX in these pa tients with asymptomatic pHPT remains controversial. In 1991 criteria were defined at a NIH-consensus conference, according to which patients qualify for either operative therapy or long term medical surveillance. Until now, it was generally believed that the majority of asymptomatic patients would never develop symptoms. In a epidemiological cohort-study, the perioperative data of 582 consecutiv e patients with pHPT, including 116 asymptomatic patients (20.9%), who unde rwent parathyroidectomy between 1987 and 1998 were evaluated by uni- and mu ltivariate analysis. At a median of 72 months postoperatively, all patients underwent a planned follow-up which included a standardised, validated que stionnaire, physical examination and laboratory investigations. Eighty-six patients who were asymptomatic preoperatively were available for follow-up. Only eight (9.3%) were definitely asymptomatic, 4.6% of the entire, repres entative cohort. Postoperative improvement was reported in 81.4% of the "as ymptomatic" patients. Multivariate analysis did not reveal a single or a se t of preoperative measurements, that would allow to predict the retrospecti vely definitely asymptomatic patient. PTX resulted in normocalcaemia in 98. 8% of preoperatively asymptomatic patients, with an operative morbidity of 1.2% and no mortality. Many apparently asymptomatic patients with pHPT will only realise that they did in fact have preoperative symptoms in retrospec t, following PTX. This study suggests that using an up-to-date definition o f asymptomatic pHPT, there are only a small number of truly asymptomatic pa tients and that these cannot be predicted preoperatively, as their symptoms may become apparent only after PTX. "Asymptomatic" patients with pHPT may share the same objective and subjective benefits from PTX as symptomatic pa tients. They should be operated as soon as the diagnosis is established.