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Surgical treatment of secondary hyperparathyroidism in elderly patients: an institutional experience

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Abstract

Background

Secondary hyperparathyroidism in elderly fragile patients presents clinical difficulties due to severity of symptoms and related comorbidity. The optimal surgical approach for this group of patients is still debated.

Aim

The aim of the study was to define the optimal technique of parathyroidectomy in elderly patients with secondary hyperparathyroidism.

Methods

Retrospective analysis in a series of 253 patients including 35 elderly individuals at a single institution was carried out. Postoperative parathyroid hormone decrease, surgical complications and symptoms control were analyzed for all patients in relation to the types of parathyroidectomy performed.

Results

In elderly patients, total parathyroidectomy was the most used approach. Subtotal parathyroidectomy was mostly reserved for younger patients suitable for kidney transplantation. No elderly patients treated with total parathyroidectomy were autotransplanted. No significant difference in surgical complications was observed between younger and elderly patients and considering the different procedures. Adequate symptom control after surgery was achieved in almost 90% of patients. A limited rate of recurrence requiring repeat surgery was observed only after subtotal parathyroidectomy.

Discussion

Considering the features of all types of parathyroidectomy, very low recurrence rate, contained postoperative hypocalcemia and limited complications following total parathyroidectomy, might represent specific advantages for elderly patients.

Conclusions

Total parathyroidectomy without parathyroid transplantation is safe for elderly patients with secondary hyperparathyroidism and a good alternative to the well-established total parathyroidectomy with autografting.

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Abbreviations

SHPT:

Secondary hyperparathyroidism

PTH:

Parathyroid hormone

MIBI:

Sestamibi scintigraphy

US:

Ultrasound

CT:

Computed tomography

MRI:

Magnetic resonance imaging

SPECT:

Single positron emission computed tomography

iPTH:

Intraoperative PTH

IONM:

Intraoperative nerve monitoring

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Authors and Affiliations

  1. UOC Chirurgia Generale e Specialità Chirurgiche, Endocrine Surgery Unit, Medical School, S. Maria University Hospital, University of Perugia, via Tristano di Joannuccio 1, 05100, Terni, Italy

    Andrea Polistena, Alessandro Sanguinetti, Roberta Lucchini, Segio Galasse, Stefano Avenia, Massimo Monacelli & Nicola Avenia

  2. Surgical Department, Skåne University Hospital, University of Lund, Malmö, Sweden

    Louis Banka Johnson & Bengt Jeppsson

Authors
  1. Andrea Polistena
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  2. Alessandro Sanguinetti
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  3. Roberta Lucchini
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  4. Segio Galasse
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  5. Stefano Avenia
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  6. Massimo Monacelli
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  7. Louis Banka Johnson
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  8. Bengt Jeppsson
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  9. Nicola Avenia
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Corresponding author

Correspondence to Andrea Polistena.

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The authors declare that they have no conflict of interest.

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For this type of study, formal consent is not required.

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Informed consent was obtained from all individual participants included in the study.

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Polistena, A., Sanguinetti, A., Lucchini, R. et al. Surgical treatment of secondary hyperparathyroidism in elderly patients: an institutional experience. Aging Clin Exp Res 29 (Suppl 1), 23–28 (2017). https://doi.org/10.1007/s40520-016-0669-4

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  • DOI: https://doi.org/10.1007/s40520-016-0669-4

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