title: Five-year longitudinal evaluation of mild primary hyperparathyroidism - medical treatment versus clinical observation.
abstract: BACKGROUND
  Primary hyperparathyroidism (PHPT) is an increasingly common endocrine disorder. Most patients with PHPT do not have disease-specific symptoms. The management of these patients has been widely debated. Recent studies have shown the importance of following up asymptomatic patients in order to reduce co-morbidity. However, there are conflicting opinions as to medical management. The aim of our study was to compare the outcome of PHPT patients on antiresorptive therapy vs. observation only.
  
  
  METHODS
  We longitudinally evaluated 157 PHPT patients (126 females) aged 22-90 years. Patients who did not undergo surgery were divided into two groups: those on anti-resorptive therapy (N = 52), and those without any treatment (N = 37). Patients who were disease-free after surgery (N = 50) served as controls.
  
  
  RESULTS
  The values of serum calcium (S-Ca), parathyroid hormone (PTH) and indices of bone metabolism did not differ significantly among the three groups of subjects. No differences in 25(OH)-vitamin D levels were noted. Bone mineral density (BMD) was not significantly different at the spinal level. Finally, we found no evidence of an effect of medical treatment on quality of life (QoL). However, QoL significantly improved in the surgery group after parathyroidectomy (PTX).
  
  
  CONCLUSIONS
  This study provided up-to-date information in terms of biochemical progression on the natural history of PHPT patients. No significant differences emerged between anti-resorptive therapy and observation only. It is not yet possible to assess the effect of pharmacological treatments on QoL in statistical terms.
authors.affiliation: Department of Internal Medicine, University of Genoa, Genoa, Italy. vera.lara79@yahoo.it.
authors.forename: Lara
authors.initials: L
authors.lastname: Vera
authors.forename: Martina
authors.initials: M
authors.lastname: Accornero
authors.forename: Mara
authors.initials: M
authors.lastname: Dolcino
authors.forename: Silvia
authors.initials: S
authors.lastname: Oddo
authors.forename: Massimo
authors.initials: M
authors.lastname: Giusti
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D050071:Bone Density Conservation Agents / Q000627:therapeutic use; D018450:Disease Progression; D005260:Female; D006304:Health Status; D006801:Humans; D049950:Hyperparathyroidism, Primary / Q000188:drug therapy / Q000601:surgery / Q000628:therapy*; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D011788:Quality of Life; D055815:Young Adult
chemical_list: D050071:Bone Density Conservation Agents