Primary hyperparathyroidism in the elderly

Hadar Duskin-Bitan; Nina Nemirovsky; Ilana Slutzky-Shraga; Eyal Robenshtok; Talia Diker-Cohen; Ilan Shimon; Dania Hirsch; Gloria Tsvetov

doi:10.1530/endoabs.56.P209

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Endocrine Abstracts (2018) 56 P209 | DOI: 10.1530/endoabs.56.P209

ECE2018 Poster Presentations: Calcium and Bone Calcium & Vitamin D metabolism (59 abstracts)

Primary hyperparathyroidism in the elderly

Hadar Duskin-Bitan ^1, , Nina Nemirovsky ³ , Ilana Slutzky-Shraga ^1, , Eyal Robenshtok ^1, , Talia Diker-Cohen ^1, , Ilan Shimon ^1, , Dania Hirsch ^1, & Gloria Tsvetov ^1,

Err

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¹Institute of Endocrinology, Diabetes and Metabolism, Rabin Medical Center, Petah-Tikva, Israel; ²Sackler Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel; ³Medicine F, Rabin Medical Center, Petah-Tikva, Israel; ⁴Medicine A, Rabin Medical Center, Petah-Tikva, Israel.

Introduction: Primary hyperparathyroidism (PHPT) is the third most common endocrinopathy. Data on PHPT in the elderly are scarce.

Objective: To characterize elderly patients with PHTP, clinically and biochemically.

Patients: A total of 216 patients (73.6% females) aged≥75 years were diagnosed and followed at a single tertiary medical center for PHPT.

Results: Mean follow-up was 11.3±5.5 years. Age at diagnosis was 70.9±7.2 years, and at last follow-up, 82.3±5.2 years. Maximal serum calcium and maximal PTH were 11.6±0.7 mg/dl and 3±2.7 X upper limit of normal (UNL), respectively. Mean urinary calcium and vitamin D levels were 208±130 mg/24 hours and 51.9±19.1 nmol/l, respectively. Serum creatinine was 0.9±0.5. Osteoporosis was diagnosed in 135 patients (62.5%; 92 with fractures, 75 after PHPT diagnosis), and nephrolithiasis, in 50; only 49 patients (22.7%) had neither. Thirty-six patients underwent parathyroidectomy: they were younger than the non-operated patients at diagnosis (67.4±9.5 vs 71.6±6.3 years) and had higher serum and urinary calcium levels. Patients ≥ 70 years at diagnosis (n=128), compared to younger patients, had significantly lower levels of calcium (10.2±0.7 vs 10.4±0.8 mg/dl, P=0.05) and PTH (1.7 vs 2.1 X UNL, P=0.05) at last follow-up. The younger patients had more nephrolithiasis (29.9% vs 18.8%). In the whole cohort, serum and urinary calcium significantly (P=0.001) decreased and vitamin D level significantly increased at last visit (10.3±0.47, 172.5±116, 68.6±23, respectively) compared with levels at diagnosis (10.6±0.7, 237±148, 51.5±19, respectively). Thirty-nine patients died during follow-up: they were significantly (P=0.001) older than the remaining patients at diagnosis (75.2±6.1 vs 70.2±6.1 years) and last follow up (85.3±5.9 vs 81.6±4.8 years), with no differences in laboratory variables.

Conclusions: Most elderly patients with PHPT had at least one indication for parathyroidectomy, but only 17% were operated. Serum and urinary calcium levels decreased during follow-up.