Endocrine Abstracts

Introduction: Primary hyperparathyroidism (PHPT) is the third most common endocrine disease, the incidence is greater in women (ratio 3-4:1) and the prevalence increases with age (1). Surgery is the only curative treatment and usually in elderly patients there is a delay or are not considered for parathyroidectomy due to perceived high operative risk or postoperative complications (2)

Clinical Case: A 84 year-old female patient was under treatment with Cinacalcet since the diagnosis of PHPT four years ago, at the beginning she was not considered for surgery due to her age and comorbidities (kidney disease, prefrailty stage). In the last year patient suffered a worsening of cognitive decline, affecting medication compliance and water intake, being admitted at the hospital with hypercalcemia of 16 mg/dl with neurological and kidney function impairment, after the administration of intravenous hydration, zoledronic acid and calcitonin, calcium levels went to normal. Surgery was done after outweigh benefits over the risks. The ultrasound and scintigraphy localized the parathyroid adenoma superior to the right thyroid lobe, intraoperative PTH levels decreased in more than 50% resulting in normal PTH and calcium levels, and the anatomy pathology confirmed adenoma. Although the patient was able to get discharged she had prolonged stay in hospital as consequence of nosocomial pneumonia and urinary tract infection.

Conclusion: Albeit there is risk for any procedure and an inverse association for parathyroidectomy in older patients (3), data have shown that surgery is safe in the elderly, improves the symptoms and quality of life (4). So surgery should not be ruled out as complications can come from that decision particularly in a patient with no adherence to medical treatment and improvement was not expected without parathyroidectomy.

References: 1. Yu N, Donnan PT, Murphy MJ, Leese GP. Epidemiology of primary hyperparathyroidism in Tayside, Scotland, UK. Clin Endocrinol (Oxf). 2009;71(4):485-493. doi:10.1111/j.1365-2265.2008.03520.x.2. Politz D, Norman J. Hyperparathyroidism in patients over 80: clinical characteristics and their ability to undergo outpatient parathyroidectomy. Thyroid. 2007;17(4):333-339. doi:10.1089/thy.2006.0259.3. Seib CD, Suh I, Meng T, et al. Patient Factors Associated With Parathyroidectomy in Older Adults With Primary Hyperparathyroidism. JAMA Surg. 2021;156(4):334-342. doi:10.1001/jamasurg.2020.6175.4. Stechman MJ, Weisters M, Gleeson FV, Sadler GP, Mihai R. Parathyroidectomy is safe and improves symptoms in elderly patients with primary hyperparathyroidism (PHPT). Clin Endocrinol (Oxf). 2009;71(6):787-791. doi:10.1111/j.1365-2265.2009.03540.x