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Observation vs. Surgery for Asymptomatic Primary Hyperparathyroidism

No significant differences in quality of life were noted between the surgery group and the observation group.

Many patients are diagnosed with primary hyperparathyroidism when mild hypercalcemia is discovered incidentally. Observation is considered acceptable for such patients if they are asymptomatic and serum calcium is only mildly elevated. However, some clinicians believe that many "asymptomatic" patients actually have subtle symptoms and would benefit from surgery.

In this Scandinavian trial, 191 patients with mild, presumably asymptomatic, hyperparathyroidism (mean serum calcium, 10.8 mg/dL) were randomized to observation or to parathyroidectomy. The authors provide data for the first 99 patients to have completed 1- and 2-year follow-up visits, at which quality of life was monitored using standardized surveys. Although a few minor differences between the surgical and medical groups were noted at 2 years, no significant differences emerged in most quality-of-life and psychological domains. Statistically borderline improvements in bone density were noted at the lumbar spine and femoral neck (but not at the radius) in the surgical group compared with the observation group at 2 years. Mean serum calcium remained stable during follow-up in the observation group.

Comment: In this randomized trial, surgery did not appear to improve quality of life in patients with mild asymptomatic primary hyperparathyroidism, but trends toward improved bone density were noted. The results support the view that observation without surgery is acceptable for selected patients. Participants in an NIH-sponsored workshop have published widely referenced criteria for surgery in patients with asymptomatic primary hyperparathyroidism (J Clin Endocrinol Metab 2002;87:5353).

— Allan S. Brett, MD

Published in Journal Watch General Medicine May 22, 2007

Citation(s):

Bollerslev J et al. Medical observation, compared with parathyroidectomy, for asymptomatic primary hyperparathyroidism: A prospective, randomized trial. J Clin Endocrinol Metab 2007 May; 92:1687-92.

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