Presentation, management, and outcomes of hyperparathyroidism in octogenarians and nonagenarians.
BACKGROUND
Various elective surgical procedures are routinely performed on patients ≥80 years of age. With primary hyperparathyroidism (PHPT), surgical management is the only treatment. The goal of this study was to compare presentation and outcome of patients ≥80 to that of those <80 years of age.


METHODS
Retrospective review of a prospectively collected database of all parathyroidectomies for PHPT performed at a university hospital. Patients ≥80 years at the time of surgery compared with patients <80 years.


RESULTS
Over 13 years, 1,826 patients underwent parathyroidectomy for PHPT. A total of 154 patients were ≥80 years at the time of surgery (8.4 %), ranging from 80 to 91 years. Patients ≥80 years had higher serum PTH, creatinine and vitamin D levels and lower T scores. Calcium levels were similar. Patients ≥80 years had a greater history of hypertension, coronary artery disease, congestive heart failure, and stroke. Psychiatric disease was less common. Patients ≥80 years had the procedure under local anesthesia only more often. Use of a unilateral approach was equivalent. Rates of adenoma, double adenoma, and hyperplasia were comparable. Patients ≥80 years were observed overnight more frequently. Stays >24 h and disease recurrence and persistence, as well as morbidity rates, were all equivalent.


CONCLUSIONS
Disease presentation of PHPT in patients ≥80 is similar to <80. Despite increased comorbidities, parathyroidectomy is a safe procedure in this patient population with a noted equivalent complication rate to younger patients. Operative management remains the only treatment. Patient age should not be a deterrent to offer curative surgical intervention.
Section of Endocrine Surgery, Department of Surgery, University of Wisconsin-Madison, Madison, WI, USA.
Sarah C
SC
Oltmann
David F
DF
Schneider
Rebecca S
RS
Sippel
Herbert
H
Chen
D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006961:Hyperparathyroidism / Q000097:blood / Q000175:diagnosis / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D010281:Parathyroid Hormone / Q000097:blood; D016105:Parathyroidectomy; D011379:Prognosis; D011446:Prospective Studies; D012189:Retrospective Studies
D010281:Parathyroid Hormone