Primary hyperparathyroidism: no biochemical progression in mild asymptomatic disease.

Clinical bottom line (level 2c)

In patients with mild asymptomatic primary hyperparathyroidism who had surgery withheld, there was no significant biochemical progression.

Rao et al: Journal of Clinical Endocrinology and Metabolism 1988; 67 (6): 1294-1298

Expires June 2003

The study

Outcome study with ?objective ?blinded outcomes, not adjusted for confounding factors, not validated in an independent set of patients.

Setting: general hospital, USA

80 patients (aged mean 61 years, 80% female) mild primary hyperparathyroidism with no surgery- criteria:

persistent hypercalcaemia (2.65 mmol/l or more) with no indication for another cause

evidence of parathyroid hormone (PTH) hypersecretion

increased or nonsuppressed values for serum PTH or urinary nephrogenic cAMP excretion per unit glomerular filtrate

Criteria for withholding surgery:

absence of symptoms attributable to hyperparathyroidism

absence of current stone disease

serum calcium below 3.0 mmol/l

serum creatinine below 133 micromol/l

absence of radiographic evidence of osteitis fibrosa

forearm bone density not more than 2.5 SD below mean value expected for age, sex, race

conservative management

Outcomes studied:

The evidence

There was no significant change in any of the biochemical indices:
- serum calcium
- serum phosphate
- serum creatinine
- serum alkaline phosphatase
- serum parathyroid hormone
- urinary calcium
- creatinine clearance

Citation

Rao DS, Wilson RJ, Kleerekoper M: Lack of biochemical progression or continuation of accelerated bone loss in mild asymptomatic primary hyperparathyroidism: Evidence for biphasic disease course. Journal of Clinical Endocrinology and Metabolism 1988; 67 (6): 1294-1298

Contributor: Clare Wotton and Musab Hayatli, June 2000
Reviewer:

_{Clinical Question.}

_Patient	_{primary hyperparathyroidism}
_{Intervention or Exposure}	_{no surgery}
_Outcome	_{progression of accelerated bone loss}