title: Surgery for 'asymptomatic' mild primary hyperparathyroidism improves some clinical symptoms postoperatively.
abstract: OBJECTIVE
  Most primary hyperparathyroidism (pHPT) patients do not conform to the guidelines for parathyroidectomy established by an international panel of specialists and have a mild pHPT. This group is typically defined as 'asymptomatic'. The primary aim of this study was to determine symptom improvement in this 'asymptomatic' group after parathyroidectomy. Secondly, we aimed to create a preoperative clinical score predicting postoperative symptom resolution.
  
  
  METHODS
  A prospective nonrandomized study included patients with mild pHPT.
  
  
  METHODS
  A questionnaire (22 items) was given to 'asymptomatic' patients preoperatively and at 3, 6, and 12 postoperative months. A logistic regression was performed to create a preoperative clinical score.
  
  
  RESULTS
  One hundred and sixteen patients were included. Postoperatively, HPT was resolved in 98% of patients. Twelve of 22 nonspecific symptoms were improved at 1 year. Subgroups analysis showed a greater improvement in patients <70 years and those with a serum calcium level ≥2.6 mmol/l preoperatively. A clinical score, based on age and five symptoms, was established to predict the clinical improvement after surgery in mild pHPT patients with a positive predictive value of 81%.
  
  
  CONCLUSIONS
  Patients with asymptomatic pHPT have clinical improvement of their symptoms postoperatively even after 1 year. Younger patients and those with higher preoperative calcium levels show the best improvement.
authors: Clinique de Chirurgie Digestive et Endocrinienne (CCDE), Institut des Maladies de l'Appareil Digestive (IMAD), Centre Hospitalier Universitaire (CHU) Nantes-Hôtel Dieu, Place Alexis Ricordeau, 44093 Nantes, France.
authors: Claire
authors: C
authors: Blanchard
authors: Muriel
authors: M
authors: Mathonnet
authors: Frédéric
authors: F
authors: Sebag
authors: Cécile
authors: C
authors: Caillard
authors: Antoine
authors: A
authors: Hamy
authors: Christelle
authors: C
authors: Volteau
authors: Marie-Françoise
authors: MF
authors: Heymann
authors: Vincent
authors: V
authors: Wyart
authors: Delphine
authors: D
authors: Drui
authors: Malanie
authors: M
authors: Roy
authors: Bertrand
authors: B
authors: Cariou
authors: Françoise
authors: F
authors: Archambeaud
authors: Patrice
authors: P
authors: Rodien
authors: Jean-François
authors: JF
authors: Henry
authors: Rasa
authors: R
authors: Zarnegar
authors: Jean-Benoît
authors: JB
authors: Hardouin
authors: Eric
authors: E
authors: Mirallié
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D002118:Calcium / Q000097:blood; D003404:Creatinine / Q000097:blood; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006887:Hydroxycholecalciferols / Q000097:blood; D049950:Hyperparathyroidism, Primary / Q000523:psychology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D016105:Parathyroidectomy; D011184:Postoperative Period; D011446:Prospective Studies; D016896:Treatment Outcome
chemical_list: D006887:Hydroxycholecalciferols; D003404:Creatinine; D002118:Calcium