Clinical presentation and management of patients with primary hyperparathyroidism in Italy.
J Endocrinol Invest
; 41(11): 1339-1348, 2018 Nov.
Article
en En
| MEDLINE
| ID: mdl-29616419
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.Palabras clave
Texto completo:
1
Base de datos:
MEDLINE
Asunto principal:
Hormona Paratiroidea
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Glándulas Paratiroides
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Calcio
/
Hiperparatiroidismo Primario
Tipo de estudio:
Clinical_trials
/
Diagnostic_studies
/
Guideline
/
Observational_studies
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Prognostic_studies
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Risk_factors_studies
País/Región como asunto:
Europa
Idioma:
En
Revista:
J Endocrinol Invest
Año:
2018
Tipo del documento:
Article