[Management of asymptomatic hyperparathyroidism].
Over the last 20 years, widespread assay of serum calcium in patients with diverse and often minor symptomatology and its introduction into routine check-up lists in perfectly healthy subjects has led to the identification of asymptomatic hyperparathyroidism defined as apparently isolated hypercalcalcaemia. In most subjects, the diagnosis is easily confirmed by assaying intact parathormone 1-84. The real problem is management of this condition, particularly in elderly subjects. Due to the lack of any truely effective medical treatment, the only alternative is between abstention and surgical exeresis. A critical analysis of the literature on the risks involved in untreated asymptomatic hyperparathyroidism compared with surgery indicates that the decision can be simple in certain specific cases. Surgery is indicated in young subjects and abstention in case of patient refusal or contraindications for surgery. In all other cases, age, the possibility of prolonged follow-up and patient demands must be carefully weighed before decision making. Prospective studies comparing abstention and surgery are needed to determine prognostic criteria.
Service de Médecine V, Hôpital Louis Mourier, Colombes.
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Vinceneux
D000328:Adult; D000368:Aged; D006801:Humans; D006961:Hyperparathyroidism / Q000453:epidemiology / Q000503:physiopathology / Q000628:therapy*; D008875:Middle Aged; D016105:Parathyroidectomy; D012307:Risk Factors; D013997:Time Factors
Prise en charge de l'hyperparathyroïdie asymptomatique.