Clinical presentation and management of patients with primary hyperparathyroidism in Italy

F. Saponaro, F. Cetani, A. Repaci, U. Pagotto, C. Cipriani, J. Pepe, S. Minisola, C. Cipri, F. Vescini, A. Scillitani, A. Salcuni, S. Palmieri, C. Eller-Vainicher, I. Chiodini, B. Madeo, E. Kara, E. Castellano, G. Borretta, L. Gianotti, F. RomanelliV. Camozzi, A. Faggiano, S. Corbetta, L. Cianferotti, M. L. Brandi, M. L. de Feo, A. Palermo, G. Vezzoli, F. Maino, M. Scalese, C. Marcocci

Research output: Contribution to journalArticlepeer-review

Abstract

Purpose: Evaluation of the phenotype of primary hyperparathyroidism (PHPT), adherence to International Guidelines for parathyroidectomy (PTx), and rate of surgical cure. Method: 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.Results: 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. Conclusions: 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.

Original languageEnglish
Pages (from-to)1339-1348
Number of pages10
JournalJournal of Endocrinological Investigation
Volume41
Issue number11
DOIs
Publication statusPublished - 2018

Keywords

  • Parathyroid adenoma
  • Parathyroid imaging
  • Parathyroidectomy
  • Serum calcium

ASJC Scopus subject areas

  • Endocrinology, Diabetes and Metabolism
  • Endocrinology

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