title: Surgical management of primary hyperparathyroidism in older adults.
abstract: OBJECTIVE
  To compare the feasibility, safety, and outcome of parathyroidectomy in the management of primary hyperparathyroidism (PHPT) in individuals aged 75 and older with that of those younger than 50.
  
  
  METHODS
  Retrospective chart review.
  
  
  METHODS
  Department of Endocrine Surgery, Hospital Paul Desbief (Marseille, France).
  
  
  METHODS
  Individuals who underwent surgery from June 2005 to February 2013 (N = 526) had a clinical examination and laboratory and imaging assessments to diagnose PHPT.
  
  
  METHODS
  The clinical and biochemical characteristics and surgery outcomes of individuals younger than 50 (n = 80) were compared with the characteristics and outcomes of those aged 75 and older (n = 89).
  
  
  RESULTS
  Most of the participants did not have any specific signs of PHPT, and the diagnosis of PHPT was established in some participants during routine clinical and laboratory examination. Nephrolithiasis and osteitis fibrosa cystica were observed only in the younger group. Urinary calcium decreased with age. Nine participants aged 75 and older did not undergo surgery (four declined, five had medical contraindications). Conventional surgery through transverse cervicotomy was used in the majority of participants. Cure rate was excellent (158/160), with few and reversible minor complications. The coexistence of thyroid lesions was significantly higher in the older (47.5%) than in the younger group (32.3%). Nodules and multinodular goiters were removed in the majority of participants during the parathyroidectomy procedure.
  
  
  CONCLUSIONS
  With the exception of a few cases with severe associated comorbidities, parathyroidectomy is safe and curative and should be considered as first-line choice for older adult with PHPT.
authors.affiliation: Department of Endocrine Surgery, European Hospital, Marseille, France.
authors.forename: Anne
authors.initials: A
authors.lastname: Denizot
authors.forename: Michel
authors.initials: M
authors.lastname: Grino
authors.forename: Charles
authors.initials: C
authors.lastname: Oliver
mesh_terms: D000236:Adenoma / Q000175:diagnosis / Q000601:surgery; D000367:Age Factors; D000368:Aged; D002118:Calcium / Q000652:urine; D005240:Feasibility Studies; D005260:Female; D006042:Goiter / Q000453:epidemiology / Q000601:surgery; D006801:Humans; D049950:Hyperparathyroidism, Primary / Q000601:surgery*; D006965:Hyperplasia; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000706:statistics & numerical data; D053040:Nephrolithiasis / Q000453:epidemiology; D010002:Osteitis Fibrosa Cystica / Q000453:epidemiology; D010280:Parathyroid Glands / Q000473:pathology / Q000601:surgery; D010282:Parathyroid Neoplasms / Q000175:diagnosis / Q000601:surgery; D016105:Parathyroidectomy / Q000379:methods; D011183:Postoperative Complications; D012189:Retrospective Studies; D016606:Thyroid Nodule / Q000453:epidemiology / Q000601:surgery
chemical_list: D002118:Calcium
keywords: old people; parathyroidectomy; primary hyperparathyroidism; thyroid nodules