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Volume 341:1249-1255 October 21, 1999 Number 17 Next

	Full Text PDF Editorial by Utiger, R. D. Add to Personal Archive Add to Citation Manager Notify a Friend E-mail When Cited Related Article PubMed Citation

ABSTRACT

Background In the United States, most patients with primary hyperparathyroidism have few or no symptoms. The need for parathyroidectomy to treat all patients with this disorder has therefore been questioned.

Methods We studied the clinical course and development of complications for periods of up to 10 years in 121 patients with primary hyperparathyroidism, 101 (83 percent) of whom were asymptomatic. There were 30 men and 91 women (age range, 20 to 79 years). During the study, 61 patients (50 percent) underwent parathyroidectomy, and 60 patients were followed without surgery.

Results Parathyroidectomy in patients with or without symptoms led to normalization of serum calcium concentrations and a mean (±SE) increase in lumbar-spine bone mineral density of 8±2 percent after 1 year (P=0.005) and 12±3 percent after 10 years (P=0.03). Bone mineral density of the femoral neck increased 6±1 percent after 1 year (P=0.002) and 14±4 percent after 10 years (P=0.002). Bone mineral density of the radius did not change significantly. The 52 asymptomatic patients who did not undergo surgery had no change in serum calcium concentration, urinary calcium excretion, or bone mineral density. However, 14 of these 52 patients (27 percent) had progression of disease, defined as the development of at least one new indication for parathyroidectomy. All 20 patients with symptoms had kidney stones. None of the 12 who underwent parathyroidectomy had recurrent kidney stones, whereas 6 of the 8 patients who did not undergo surgery did have a recurrence.

Conclusions In patients with primary hyperparathyroidism, parathyroidectomy results in the normalization of biochemical values and increased bone mineral density. Most asymptomatic patients who did not undergo surgery did not have progression of disease, but approximately one quarter of them did have some progression.

Source Information

From the Departments of Medicine (S.J.S., E. Shane, T.P.J., E. Siris, J.P.B.) and Pharmacology (J.P.B.), College of Physicians and Surgeons, Columbia University, New York.

Address reprint requests to Dr. Silverberg at the Department of Medicine, College of Physicians and Surgeons, 630 W. 168th St., New York, NY 10032.

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