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. 2003 Sep 6;327(7414):530-4.
doi: 10.1136/bmj.327.7414.530.

Cohort study on effects of parathyroid surgery on multiple outcomes in primary hyperparathyroidism

Peter Vestergaard  1 , Leif Mosekilde
Affiliations

Cohort study on effects of parathyroid surgery on multiple outcomes in primary hyperparathyroidism

Peter Vestergaard et al. BMJ. .

Abstract

Objectives: To assess the effects of surgery compared with conservative treatment (no surgery) for primary hyperparathyroidism.

Design: Cohort study.

Setting: Nationwide Danish cohort.

Participants: 3213 patients, mean age 61 (SD 16) years, with a diagnosis of primary hyperparathyroidism between 1980 and 1999. 1934 (60%) underwent surgery and 1279 (40%) were treated conservatively.

Main outcome measures: Occurrence of fractures, osteoporosis, kidney or urinary tract stones, acute myocardial infarction, angina pectoris, cardiac arrhythmias, arterial hypertension, heart failure, stroke, acute pancreatitis, stomach or duodenal ulcers, muscle pain, malignant diseases, psychiatric disorders, and mortality.

Results: At diagnosis of primary hyperparathyroidism, patients who subsequently underwent surgery had a lower prevalence of previous fracture (odds ratio 0.64, 95% confidence interval 0.51 to 0.80), acute myocardial infarction (0.59, 0.42 to 0.83), stroke (0.57, 0.37 to 0.88), psychiatric disorders (0.54, 0.31 to 0.94), and painful muscle disorders (0.44, 0.26 to 0.76), whereas kidney stones (2.49, 1.93 to 3.23) and acute pancreatitis (2.77, 1.33 to 5.76) were more prevalent. After diagnosis, the risks of fractures (hazards ratio 0.69, 0.56 to 0.84) and gastric ulcers (0.59, 0.41 to 0.84) were lower in patients treated surgically than those treated conservatively. Events involving kidney or urinary tact stones were more prevalent in patients treated surgically than patients treated conservatively (1.87, 1.30 to 2.68). Mortality was lower in patients treated surgically (0.65, 0.57 to 0.73).

Conclusions: Patients treated surgically for primary hyperparathyroidism have a lower prevalence of fractures and gastric ulcers than patients treated conservatively. The type of treatment had no effect on the occurrence of cardiovascular events.

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Figures

Figure 1
Figure 1
Kaplan-Meier plot of survival in surgically and conservatively treated patients with primary hyperparathyroidism. Death during follow up occurred in 591 (31%) surgically treated patients and 474 (37%) conservatively treated patients
See this image and copyright information in PMC

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References

    1. Vestergaard P, Mollerup CL, Frøkjær VG, Christiansen P, Blichert-Toft M, Mosekilde L. Cohort study of risk of fracture before and after surgery for primary hyperparathyroidism. BMJ 2000;321: 598-602. - PMC - PubMed
    1. Mollerup CL, Vestergaard P, Frøkjær VG, Mosekilde L, Christiansen P, Blichert-Toft M. Risk of renal stone events in primary hyperparathyroidism before and after parathyroid surgery: controlled retrospective follow up study. BMJ 2002;325: 807-12. - PMC - PubMed
    1. Roberts WC, Waller BF. Effect of chronic hypercalcemia on the heart. An analysis of 18 necropsy patients. Am J Med 1981;71: 371-84. - PubMed
    1. Hedbäck G, Oden A, Tisell LE. The influence of surgery on the risk of death in patients with primary hyperparathyroidism. World J Surg 1991;15: 399-405. - PubMed
    1. Palmér M, Adami H-O, Bergstrøm R, Åkerström G, Ljunghall S. Mortality after surgery for primary hyperparathyroidism: a follow-up of 441 patients operated on from 1956-1979. Surgery 1987;102: 1-7. - PubMed