Underutilization of Parathyroidectomy in Elderly Patients with Primary Hyperparathyroidism

Overview

Journal J Clin Endocrinol Metab

Publisher Oxford University Press

Specialty Endocrinology

Date 2010 Jul 9

PMID 20610600

Citations 33

Authors

Bian Wu

Philip I Haigh

Roy Hwang

Philip H G Ituarte

In-Lu Amy Liu

Theodore J Hahn

Michael W Yeh

Affiliations

Soon will be listed here.

Abstract

Context: Primary hyperparathyroidism (PHPT) disproportionately affects older patients, who may face higher thresholds for surgical intervention compared to young patients.

Objective: The aim was to examine for differences in the utilization of parathyroidectomy attributable to age.

Design: We conducted a retrospective cohort study.

Participants: Patients with biochemically diagnosed PHPT during the years 1995-2008 were identified within an integrated health care delivery system in Southern California encompassing approximately 3 million individuals.

Main Outcome Measures: The outcome measures were parathyroidectomy (PTx) and time interval to surgery.

Results: We found 3388 patients with PHPT, 964 (28%) of whom underwent PTx. Patients aged 60+ yr comprised 60% of the study cohort. The likelihood of PTx decreased linearly among patients aged 60+ when compared to patients aged 50-59, an effect that persisted in multivariate analysis: odds ratio 0.68 for ages 60-69 (P < 0.05); 0.41 for ages 70-79 (P < 0.0001), and 0.11 for age 80+ (P < 0.0001). The PTx rate for patients aged 70+ was 14%. Among patients meeting 2002 consensus criteria for surgical treatment, 45% of those aged 60-69 and 24% of those aged 70+ underwent PTx. A Cox proportional hazards model showed that patients aged 60+ experienced significantly longer delays from diagnosis to surgery compared to young patients (P < 0.0001).

Conclusions: PHPT is undertreated in the elderly. We observed a progressive age-related decline in PTx rate that renders patients aged 70+ unlikely to have definitive treatment, irrespective of comorbidity and eligibility for surgery.

Citing Articles

Patient Characteristics, Management, and Outcomes in a Novel Cohort of Primary Hyperparathyroidism.

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Hypercalcemia from primary hyperparathyroidism.

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The clinical significance of calcium/magnesium ratio in primary hyperparathyroidism: unveiling a clinical association.

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Regional variations in the management of primary hyperparathyroidism in Sweden: population-based case-control study.

Thorsteinsson D, Granath F, Branstrom R, Koman A, Zedenius J, Nilsson I BJS Open. 2024; 8(1).

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Older Patients With Asymptomatic Primary Hyperparathyroidism: Should Criteria for Surgery Be Expanded?.

Bartz-Kurycki M, Dream S, Yen T, Doffek K, Shaker J, Evans D J Endocr Soc. 2023; 7(9):bvad098.

PMID: 37873505 PMC: 10590644. DOI: 10.1210/jendso/bvad098.

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