title: Mortality in sporadic primary hyperparathyroidism: nationwide cohort study of multiple parathyroid gland disease.
abstract: BACKGROUND
  The risk of dying from primary hyperparathyroidism (pHPT) is controversial and has been explored mainly in single parathyroid gland disease. The present study investigates mortality in pHPT due to multiple parathyroid gland disease.
  
  
  METHODS
  We used the nationwide Swedish In-patient Register and Cause-of-Death Registry to compare the mortality in 3485 Swedish patients subjected to parathyroidectomy during 1964 to 1999 with that of the Swedish population (standardized for age, gender, and calendar year). The patient cohort includes 36,596 person years.
  
  
  RESULTS
  Increased risk of death beyond the first postoperative year (standardized mortality ratio, 1.4; 95% CI, 1.37-1.52) was found in both sexes and for all age intervals below 80 years. The increased risk persisted more than 15 years postoperatively and related to cardiovascular diseases, diabetes mellitus, urogenital diseases, and malignant disorders. The increased risk of dying in cardiovascular diseases normalized during 1990 to 1999.
  
  
  CONCLUSIONS
  pHPT caused by multiple parathyroid gland enlargement is associated with an excessive mortality similar to pHPT of single parathyroid adenoma. The findings substantiate that modern modes of surgical treatment for pHPT normalize the risk of dying from cardiovascular complications and that the hyperpararthyroid state per se is the possible cause of the premature death.
authors.affiliation: Department of Surgery, Sodersjukhuset, Stockholkm, Sweden.
authors.forename: Inga-Lena
authors.initials: IL
authors.lastname: Nilsson
authors.forename: Charlotta
authors.initials: C
authors.lastname: Wadsten
authors.forename: Lena
authors.initials: L
authors.lastname: Brandt
authors.forename: Jonas
authors.initials: J
authors.lastname: Rastad
authors.forename: Anders
authors.initials: A
authors.lastname: Ekbom
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D005500:Follow-Up Studies; D006801:Humans; D006961:Hyperparathyroidism / Q000401:mortality* / Q000601:surgery; D008875:Middle Aged; D010279:Parathyroid Diseases / Q000145:classification / Q000401:mortality / Q000601:surgery; D016105:Parathyroidectomy / Q000401:mortality*; D016019:Survival Analysis; D013548:Sweden / Q000453:epidemiology