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, ML Brandi, ML de Feo, A Palermo, G Vezzoli, F Maino, M Scalese, C Marcocci

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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. © 2018 Italian Society of Endocrinology (SIE)
Original languageEnglish
Pages (from-to)1-10
Number of pages10
JournalJournal of Endocrinological Investigation
DOIs
Publication statusPublished - 2018

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Saponaro, F., Cetani, F., Repaci, A., Pagotto, U., Cipriani, C., Pepe, J., Minisola, S., Cipri, C., Vescini, F., Scillitani, A., Salcuni, A., Palmieri, S., Eller-Vainicher, C., Chiodini, I., Madeo, B., Kara, E., Castellano, E., Borretta, G., Gianotti, L., ... Marcocci, C. (2018). Clinical presentation and management of patients with primary hyperparathyroidism in Italy. Journal of Endocrinological Investigation, 1-10. https://doi.org/10.1007/s40618-018-0879-z