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J Clin Endocrinol Metab. 2007 Aug;92(8):3114-21. Epub 2007 May 29.

Surgery or surveillance for mild asymptomatic primary hyperparathyroidism: a prospective, randomized clinical trial.

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1
Department of Endocrinology, University of Pisa, Via Paradisa 2, 56124 Pisa, Italy.

Abstract

CONTEXT:

It is unclear whether patients with asymptomatic primary hyperparathyroidism (PHPT) do better with parathyroidectomy (PTx) as compared with conservative medical management.

OBJECTIVE:

The aim of the study was to evaluate the beneficial effect of PTx vs. conservative management in patients with mild asymptomatic PHPT.

DESIGN:

We conducted a prospective, randomized study.

SETTING:

The study took place at a referral center.

PATIENTS:

We studied 50 patients who did not meet any guidelines for parathyroid surgery as recommended by the National Institutes of Health Consensus Development Conference on Asymptomatic PHPT.

INTERVENTION:

Patients were randomly assigned to PTx or no PTx and were evaluated at 6 months and at 1 yr.

MAIN OUTCOME MEASURES:

We compared changes (percentage of basal) of lumbar spine bone mineral density (BMD) between the two groups at 1 yr.

RESULTS:

The change in BMD at lumbar spine was greater after PTx (+4.16 +/- 1.13 for PTx vs. -1.12 +/- 0.71 for no PTx; P = 0.0002). The change in BMD at the total hip was also significantly greater in the PTx group (+2.61 +/- 0.71 for PTx vs. -1.88 +/- 0.60 for no PTx; P = 0.0001). There was no difference in BMD after 1 yr between both groups at the one-third radius site. In comparison with those who did not undergo surgery, the PTx subjects, after 1 yr, showed significant differences in four quality of life measures as determined by the 36-item short form health survey scale: bodily pain (P = 0.001), general health (P = 0.008), vitality (P = 0.003), and mental health (P = 0.017).

CONCLUSIONS:

In patients with mild asymptomatic PHPT, successful PTx is followed by an improvement in BMD and quality of life. Most patients followed without surgery did not show evidence of progression.

PMID:
17535997
DOI:
10.1210/jc.2007-0219
[Indexed for MEDLINE]
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