Clinical presentation and management of patients with primary hyperparathyroidism in Italy
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Evaluation of the phenotype of primary hyperparathyroidism (PHPT), adherence to International Guidelines for parathyroidectomy (PTx), and rate of surgical cure.
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.
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.
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.
KeywordsParathyroidectomy Parathyroid adenoma Serum calcium Parathyroid imaging
The authors are very grateful to the participating patients for their cooperation. We wish to thank Drs Carmela Ostuni, Bari; Massimo Procopio, Torino; Alessandro Piovesan, Torino; Fochesato Elena Maria, Sondrio; Lettina Gabriele, Messina; Turiano Giuseppe, Messina; Roberto Allara, Vercelli; Vanessa Roncoroni, Ancona; Loredana Pagano, Novara; Federico Arecco, Torino; Marchese Lorenzo, Torino; Falcone Yolanda, Torino; Michele Zini, Reggio Emilia; Anna Ciampolillo, Bari; Fabio Ulivieri, Milano; Roberto Attanasio, Milano; Marco Sergio Massarotti, Milano; Andrea Lania, Milano; Valentina Albertino, Milano; Alberto Falchetti, Firenze; Vania Braga, Verona; Rizzato Margerita Treviso for participating in the study. This study has been conducted as part of the research projects of the Mineral and Bone Club of the Italian Society of Endocrinology.
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
This study has been approved by the appropriate institutional and/or national research ethics committee and has been performed in accordance with the ethical standards as laid down in the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.
Informed consent was obtained from all individual participants included in the study.
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