Medical Observation compared to Parathyroidectomy for Asymptomatic Primary Hyperparathyroidism: A Prospective, Randomized Trial.

Author(s): Bollerslev J, Jansson S, Mollerup CL, Nordenstrom J, Lundgren E, Torring O, Varhaug JE, Baranowski M, Aanderud S, Franco C, Freyschuss B, Isaksen GA, Ueland T, Rosen T

Affiliation(s): Section of Endocrinology, Rikshospitalet-Radiumhospitalet Medical Center, University of Oslo, Oslo, Norway; Dept. of Surgery, Sahlgrenska Hospital, Gothenburg, Sweden; Dept. of Endocrine Surgery, Copenhagen University Hospital, Rigshospitalet, Denmark; Dept. of Surgery, Karolinska University Hospital - Solna, Stockholm, Sweden; Dept. of Surgery, Akademiska Hospital, Uppsala, Sweden; Section of Endocrinology, Dept. of Medicine, Sodersjukhuset, Stockholm, Sweden; Dept. of Surgery, Haukeland University Hospital, Bergen, Norway; Dept. of Medicine, St. Olav's Hospital, University of Trondheim, Norway; Dept. of Endocrinology, Haukeland University Hospital, Bergen, Norway; Dept. of Endocrinology, Sahlgrenska Hospital, Gothenburg, Sweden; Dept of Metabolism and Endocrinology Karolinska University Hospital Huddinge, Sweden.

Publication date & source: 2007-02-06, J Clin Endocrinol Metab., [Epub ahead of print]

Publication type:

Context: The clinical presentation of primary hyperparathyroidism (pHPT) has changed during the last half century and the diagnosis is now more often made by chance in patients with no specific symptoms. Objective: The present study is a randomized controlled trial that investigates the effects of parathyroidectomy or medical observation in mild asymptomatic pHPT on morbidity and Quality of Life (QoL). Design/setting/patients: A total of 191 patients (26 men) with asymptomatic pHPT (mean age 64.2 +/- 7.4 (SD) years) were recruited in the study and randomized to medical observation (serum calcium level: 2.69 +/- 0.08 mmol/l) or surgery (2.70 +/- 0.08 mmol/l). We here report baseline, one (n = 119) and 2 years data (n = 99) on those, who had completed the follow up visits by the end of the inclusion period. Results: At baseline, the patients had significantly lower QoL (SF-36) and more psychological symptoms compared with age- and sex-matched healthy subjects. The two groups were similar at baseline and no clinically significant changes in these parameters were seen during the observation time. Calcium and PTH normalized following surgery. The areal bone mineral density (BMD) increased in the group randomized to operation, whereas the BMD remained stable in the medical observation group. No change in kidney function (creatinine) or blood pressure was observed longitudinally or between the groups. In conclusion, asymptomatic patients with mild pHPT have decreased QoL and more psychological symptoms than normal controls. No benefit of operative treatment compared to medical observation was found on these measures so far.