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J Endocrinol Invest. 2018 Nov;41(11):1339-1348. doi: 10.1007/s40618-018-0879-z. Epub 2018 Apr 3.

Clinical presentation and management of patients with primary hyperparathyroidism in Italy.

Author information

1
Department of Clinical and Experimental Medicine, University of Pisa, Via Paradisa 2, 56100, Pisa, Italy.
2
Division of Endocrinology Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy.
3
Department of Internal Medicine and Medical Disciplines, 'Sapienza' University, Rome, Italy.
4
Endocrinology and Metabolism, Unit University-Hospital of Udine, Udine, Italy.
5
Endocrinology Unit, "Casa Sollievo della Sofferenza," IRCCS, San Giovanni Rotondo, Italy.
6
Unit of Endocrinology, Fondazione IRCCS Cà Granda-Ospedale Maggiore Policlinico, Milan, Italy.
7
Unit of Endocrinology, Azienda Ospedaliero-Universitaria di Modena, Ospedale Civile di Baggiovara, Modena, Italy.
8
Division of Endocrinology, Diabetes and Metabolism, Santa Croce and Carle Hospital, Cuneo, Italy.
9
Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy.
10
Endocrine Unit, University of Padova, Padua, Italy.
11
Endocrinology, Federico II University of Naples, Naples, Italy.
12
Endocrinology Service, Department of Biomedical Sciences for Health, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy.
13
Department of Internal Medicine, University of Florence, Florence, Italy.
14
Endocrinology Unit, Careggi Hospital and University of Florence, Florence, Italy.
15
Department of Endocrinology and Diabetes, University Campus Bio-Medico, Rome, Italy.
16
Nephrology and Dialysis Unit, IRCCS Ospedale San Raffaele, Milan, Italy.
17
Department of Medical, Surgical and Neurological Sciences, University of Siena, Siena, Italy.
18
Institute of Clinical Physiology, National Council of Research, Pisa, Italy.
19
Department of Clinical and Experimental Medicine, University of Pisa, Via Paradisa 2, 56100, Pisa, Italy. claudio.marcocci@med.unipi.it.

Abstract

PURPOSE:

Evaluation of the phenotype of primary hyperparathyroidism (PHPT), adherence to International Guidelines for parathyroidectomy (PTx), and rate of surgical cure.

METHOD:

From January 2014-January 2016, we performed a prospective, multicenter study in patients with newly diagnosed PHPT. Biochemical and instrumental data were collected at baseline and during 1-year follow-up.

RESULTS:

Over the first year we enrolled 604 patients (age 61 ± 14 years), mostly women (83%), referred for further evaluation and treatment advice. Five hundred sixty-six patients had sporadic PHPT (93.7%, age 63 ± 13  years), the remaining 38 (6.3%, age 41 ± 17  years) had familial PHPT. The majority of patients (59%) were asymptomatic. Surgery was advised in 281 (46.5%). Follow-up data were available in 345 patients. Eighty-seven of 158 (55.1%) symptomatic patients underwent PTx. Sixty-five (53.7%) of 121 asymptomatic patients with at least one criterion for surgery underwent PTx and 56 (46.3%) were followed without surgery. Negative parathyroid imaging studies predicted a conservative approach [symptomatic PHPT: OR 18.0 (95% CI 4.2-81.0) P < 0.001; asymptomatic PHPT: OR 10.8, (95% CI 3.1-37.15) P < 0.001). PTx was also performed in 16 of 66 (25.7%) asymptomatic patients without surgical criteria. Young age, serum calcium concentration, 24 h urinary calcium, positive parathyroid imaging (either ultrasound or MIBI scan positive in 75% vs. 16.7%, P = 0.001) were predictors of parathyroid surgery. Almost all (94%) of patients were cured by PTx.

CONCLUSIONS:

Italian endocrinologists do not follow guidelines for the management of PHPT. Negative parathyroid imaging studies are strong predictors of a non-surgical approach. PTx is successful in almost all patients.

KEYWORDS:

Parathyroid adenoma; Parathyroid imaging; Parathyroidectomy; Serum calcium

PMID:
29616419
DOI:
10.1007/s40618-018-0879-z
[Indexed for MEDLINE]

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