Posted on March 20, 2008
Improvements found in the presentation of hyperparathyroidism
Due to an increased awareness and the establishment of
screening bone densitometry over the last three decades, patients with
hyperparathyroidism are referred to surgery sooner and have a lesser degree of
hypercalcemia, according to a study published in Archives of
Surgery.
Researchers from Rhode Island Hospital in Providence,
R.I. and Cleveland Clinic Foundation conducted a retrospective study of 300
patients with hyperparathyroidism undergoing parathyroidectomy in 1985, 1995
and 2005 to determine the changes in the emergence of the disease in the last
30 years.
Patients were similar in age and sex, and from 1985 to
2005, mean preoperative calcium levels decreased from 11.8 (0.1) mg/dL to 11.2
(0.1) mg/dL (P<.001). The researchers also reported an increase in
the number of patients with levels of preoperative calcium below 11.0 mg/dL:
10% in 1985 to 43% in 2005 (P<.001).
Researchers found that time from diagnosis to referral
decreased from 2.5 years in 1985 to 1.6 years in 2005 (P=.08). The
amount of referrals due to osteoporosis also increased: 20% of referrals due to
osteoporosis in 2005 vs. 7% in 1985 (P=.03). In men, the acknowledgment
of osteoporosis and osteopenia increased from 3% to 26% (P=.10) over the
years. – by Stacey L. Adams
Arch Surg. 2008;143:260-266.
This study carefully compared salient features of patients having
surgery for hyperparathyroidism in the years 1985, 1995 and 2005. The
increasing incidence of osteoporosis is probably related to the routine use of
BMD measurements rather than a true change in this feature. The frequency of
hyperplasia has held steady at 12%, 4% and 11% in these time periods. The lack
of follow-up in this particular study that focuses on presenting features makes
it difficult to appreciate whether hypertension, neuromuscular and
neuropsychiatric symptoms truly improve. I find that a majority of our patients
with hyperparathyroidism are asymptomatic rather than only 20% asymptomatic as
reported in this paper.
– Jerome Hershman, MD
Endocrine Today Editorial Board
member
