Prospective 10-year study of postmenopausal women with asymptomatic primary hyperparathyroidism.
OBJECTIVE
There are few prospective studies of people with asymptomatic primary hyperparathyroidism (PHPT) who have not had parathyroidectomy. We followed a group of postmenopausal women with asymptomatic PHPT for up to 10 years to determine whether they could be managed conservatively without parathyroidectomy.


METHODS
A 10-year, prospective, longitudinal study of 23 postmenopausal women with asymptomatic PHPT initially enrolled into a 4-year randomised controlled trial of hormone replacement therapy. Serum total and ionised calcium, biochemistry, urine calcium, and bone mineral density were measured every 6-12 months.


RESULTS
Serum ionised calcium, creatinine, and urine calcium:creatinine remained stable throughout follow-up. In contrast, there was a steady increase in the total and adjusted serum calcium and a small rise in serum PTH. Only one woman had an adjusted serum calcium >3.0 mmol/L during follow-up. There were few other clinical events possibly related to PHPT (1 possible episode of nephrolithiasis, 4 fractures, 1 severe osteoporosis). Three women underwent parathyroidectomy, although 19/23 women met the updated criteria for parathyroidectomy from the 2002 NIH-sponsored workshop during follow-up.


CONCLUSIONS
Many postmenopausal women with asymptomatic PHPT do not develop symptoms or complications of PHPT, and their biochemical parameters remains stable. Therefore, such asymptomatic women with PHPT can often be managed conservatively without parathyroidectomy.
Bolland
Mark J
MJ
Osteoporosis Research Group, Department of Medicine, University of Auckland, Private Bag 92 019, Auckland 1020, New Zealand. m.bolland@auckland.ac.nz
Grey
Andrew B
AB
Orr-Walker
Brandon J
BJ
Horne
Anne M
AM
Evans
Margaret C
MC
Clearwater
Judy M
JM
Gamble
Greg D
GD
Reid
Ian R
IR
D000368:Aged; D015519:Bone Density; D002118:Calcium / Q000097:blood / Q000652:urine; D005260:Female; D005500:Follow-Up Studies; D020249:Hormone Replacement Therapy; D006801:Humans; D006934:Hypercalcemia / Q000209:etiology; D049950:Hyperparathyroidism, Primary / Q000150:complications / Q000175:diagnosis* / Q000628:therapy*; D007669:Kidney Calculi / Q000209:etiology; D008875:Middle Aged; D010024:Osteoporosis / Q000209:etiology; D016105:Parathyroidectomy; D017698:Postmenopause; D011446:Prospective Studies
D002118:Calcium