The natural history of treated and untreated primary hyperparathyroidism: the parathyroid epidemiology and audit research study.
BACKGROUND
Primary hyperparathyroidism (PHPT) is a common endocrine disorder with the majority of cases being mild and untreated.


OBJECTIVE
To provide an update on the natural history of treated and untreated PHPT.


METHODS
Retrospective population-based observational study.


METHODS
From 1997 to 2006, a well-defined cohort of PHPT patients was established in Tayside, Scotland. Subsequent cohorts of 'mild untreated' and 'surgically treated' PHPT patients were selected for the present study. Their serum calcium (S-Ca) and PTH concentrations were followed until September 2009. Surgical outcomes were evaluated using hospital admission data.


RESULTS
A total of 904 'mild untreated' patients were identified (median follow-up=4.7 years), with a baseline median S-Ca of 2.62 mmol/l. A general decreased trend was observed in the S-Ca concentration for up to 12 years but an increasing trend in PTH (P<0.001 in both instances). Disease progression, defined as an increase in S-Ca concentration, was observed in 121 patients (13.4%). Twenty-six (2.9%) patients had undergone surgery during the subsequent follow-up period. Baseline age and PTH concentration were the only significant risk factors for disease progression. In comparison, there were 200 'surgically treated' patients (median follow-up=5.8 years). S-Ca was normalised after surgery, in 196 patients (98%). Hospital admissions for renal complications were reduced after surgery. In conclusion, most untreated patients with mild PHPT had no progression of S-Ca but approximately 15% did show some evidence of progression. Parathyroidectomy, with a high success rate, normalized the S-Ca in patients with PHPT.
Dundee Epidemiology and Biostatistics Unit, Division of Clinical and population Sciences and Education, MacKenzie Building, Kirsty Semple Way, University of Dundee, Dundee, Scotland, DD2 4BF, UK. n.yu@cpse.dundee.ac.uk
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Donnan
D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D002118:Calcium / Q000097:blood*; D054869:Clinical Audit; D015331:Cohort Studies; D018450:Disease Progression; D005260:Female; D006801:Humans; D049950:Hyperparathyroidism, Primary / Q000097:blood* / Q000453:epidemiology / Q000601:surgery; D008297:Male; D008875:Middle Aged; D010281:Parathyroid Hormone / Q000097:blood*; D016105:Parathyroidectomy; D012189:Retrospective Studies; D012307:Risk Factors; D012606:Scotland / Q000453:epidemiology
D010281:Parathyroid Hormone; D002118:Calcium