Surgery or surveillance for mild asymptomatic primary hyperparathyroidism: a prospective, randomized clinical trial.
BACKGROUND
It is unclear whether patients with asymptomatic primary hyperparathyroidism (PHPT) do better with parathyroidectomy (PTx) as compared with conservative medical management.


OBJECTIVE
The aim of the study was to evaluate the beneficial effect of PTx vs. conservative management in patients with mild asymptomatic PHPT.


METHODS
We conducted a prospective, randomized study.


METHODS
The study took place at a referral center.


METHODS
We studied 50 patients who did not meet any guidelines for parathyroid surgery as recommended by the National Institutes of Health Consensus Development Conference on Asymptomatic PHPT.


METHODS
Patients were randomly assigned to PTx or no PTx and were evaluated at 6 months and at 1 yr.


METHODS
We compared changes (percentage of basal) of lumbar spine bone mineral density (BMD) between the two groups at 1 yr.


RESULTS
The change in BMD at lumbar spine was greater after PTx (+4.16 +/- 1.13 for PTx vs. -1.12 +/- 0.71 for no PTx; P = 0.0002). The change in BMD at the total hip was also significantly greater in the PTx group (+2.61 +/- 0.71 for PTx vs. -1.88 +/- 0.60 for no PTx; P = 0.0001). There was no difference in BMD after 1 yr between both groups at the one-third radius site. In comparison with those who did not undergo surgery, the PTx subjects, after 1 yr, showed significant differences in four quality of life measures as determined by the 36-item short form health survey scale: bodily pain (P = 0.001), general health (P = 0.008), vitality (P = 0.003), and mental health (P = 0.017).


CONCLUSIONS
In patients with mild asymptomatic PHPT, successful PTx is followed by an improvement in BMD and quality of life. Most patients followed without surgery did not show evidence of progression.
Ambrogini
Elena
E
Department of Endocrinology, University of Pisa, Via Paradisa 2, 56124 Pisa, Italy.
Cetani
Filomena
F
Cianferotti
Luisella
L
Vignali
Edda
E
Banti
Chiara
C
Viccica
Giuseppe
G
Oppo
Annalisa
A
Miccoli
Paolo
P
Berti
Piero
P
Bilezikian
John P
JP
Pinchera
Aldo
A
Marcocci
Claudio
C
D015502:Absorptiometry, Photon; D000368:Aged; D015415:Biomarkers; D015519:Bone Density / Q000502:physiology; D002118:Calcium / Q000097:blood / Q000652:urine; D003627:Data Interpretation, Statistical; D004452:Echocardiography; D023381:Endpoint Determination; D005260:Female; D006801:Humans; D049950:Hyperparathyroidism, Primary / Q000601:surgery* / Q000628:therapy*; D007398:Interpersonal Relations; D008297:Male; D008875:Middle Aged; D010024:Osteoporosis / Q000209:etiology / Q000517:prevention & control; D010281:Parathyroid Hormone / Q000097:blood; D016105:Parathyroidectomy; D011446:Prospective Studies; D011788:Quality of Life; D013131:Spine / Q000033:anatomy & histology
D015415:Biomarkers; D010281:Parathyroid Hormone; D002118:Calcium