The Effects of Surgery for Primary Hyperparathyroidism

Abstract

Objective

Investigate the effects of parathyroidectomy vs. medical observation for patents with asymptomatic primary hyperparathyroidism (pHP).

Methods

A meta-analysis of randomized controlled trials was performed. Outcome parameters include biochemistries and bone density of the lumbar spine, femoral neck, and distal radius. Also, health-related quality of life (HRQOL) as measured by validated instruments was analyzed.

Results

A total of 5 trials involving 345 patients (163 observed, 182 surgery) were analyzed for serum calcium, 24-hour urine calcium, and serum PTH levels. Surgical treatment produced a significant decrease in all of these parameters. Mean serum and 24-hour urine calcium levels decreased from 10.6 mg/dl to 9.4 mg/dl (p<0.001), and 253 mg/d to 148 mg/d (p<0.001) respectively. Similarly, a significant decrease in serum PTH by 58 pg/ml (p<0.001) was observed. After analyzing 7 RCT involving 531 patients, bone density in both the lumbar spine [odds ratio 2.29 (1.37 – 3.85) p<0.01] and femoral neck [odds ratio 1.84 (1.106 – 3.066) p<0.02] demonstrated statistically significant improvement 2 years after parathyroidectomy when compared to observed patients. The difference in bone density of the radius did not reach statistical significance. Narrative interpreted data was available on three RCT regarding HRQOL. Primary data from authors has been requested to allow for complete analysis of this parameter.

Conclusions

For patients with asymptomatic primary hyperparathyroidism, parathyroidectomy results in a significant improvement in lumbar spine and femoral neck bone density, as well as a normalization of chemistries. HRQOL is similarly expected to be improved, however, qualitative data to support this is pending.