title: Fibromyalgia symptoms and medication requirements respond to parathyroidectomy.
abstract: BACKGROUND
  Fibromyalgia (FM), an ill-defined symptom complex, is characterized by musculoskeletal pain, headache, depression, fatigue, and cognitive decline, symptoms also seen commonly in primary hyperparathyroidism (PHP). Prevalence of concurrent PHP and FM and response to parathyroidectomy (PTX) of those with both conditions are unknown.
  
  
  METHODS
  We reviewed prospective data of 4,000 patients with sporadic PHP who had PTX from 1995 to 2013 examining perioperative symptoms and medication usage for those with diagnosed FM. Cure was defined by normocalcemia at ≥ 6 months.
  
  
  RESULTS
  Of 2,184 patients, 80 (4%) had a prior diagnosis of FM. Of evaluable FM patients, 97.3% had definitive cure of PHP. After PTX, 89% had improvement in ≥ 1 symptom attributed to FM, with improved cognition/memory most common (80%). Improvement in ≥ 2, ≥ 3, and ≥ 4 FM symptoms was appreciated by 71%, 43%, and 25%, respectively. Quality of life and wellness improved in >50%. Postoperative use of drugs prescribed for FM often improved or resolved (narcotics, 77%; anti-inflammatories, 74%; "FM-specific medications," 33%; antidepressants, 30%); 21% discontinued all FM medications postoperatively.
  
  
  CONCLUSIONS
  FM is common in patients operated on for sporadic PHP. Of those with both conditions, after PTX 89% appreciate symptom response and 77% and 21% had a decrease in or discontinuation or medications, respectively. Before diagnosing FM, providers should exclude PHP, which is surgically correctable.
authors.affiliation: Division of Endocrine Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA.
authors.forename: Cameron D
authors.initials: CD
authors.lastname: Adkisson
authors.affiliation: Division of Endocrine Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA.
authors.forename: Linwah
authors.initials: L
authors.lastname: Yip
authors.affiliation: Division of Endocrine Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA.
authors.forename: Michaele J
authors.initials: MJ
authors.lastname: Armstrong
authors.affiliation: Division of Endocrine Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA.
authors.forename: Michael T
authors.initials: MT
authors.lastname: Stang
authors.affiliation: Division of Endocrine Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA.
authors.forename: Sally E
authors.initials: SE
authors.lastname: Carty
authors.affiliation: Division of Endocrine Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA. Electronic address: McCoyKL@upmc.edu.
authors.forename: Kelly L
authors.initials: KL
authors.lastname: McCoy
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016009:Chi-Square Distribution; D015331:Cohort Studies; D015897:Comorbidity; D016208:Databases, Factual; D005260:Female; D005356:Fibromyalgia / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology*; D005500:Follow-Up Studies; D006801:Humans; D049950:Hyperparathyroidism, Primary / Q000175:diagnosis / Q000453:epidemiology* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D010149:Postoperative Pain / Q000188:drug therapy* / Q000503:physiopathology; D016105:Parathyroidectomy / Q000009:adverse effects / Q000379:methods; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D016896:Treatment Outcome