title: Presentation and Outcomes After Surgery for Primary Hyperparathyroidism During an 18-Year Period.
abstract: OBJECTIVE
  The objective of this study is to analyze whether the trend towards operating on patients with less severe primary hyperparathyroidism (pHPT) than earlier is reflected in a change of preoperative presentation and surgical outcome.
  
  
  METHODS
  In this longitudinal cohort study, patients with pHPT subjected to first time surgery were compared in three time periods: 1989-1994, 1995-2000, and 2001-2006 in this longitudinal cohort study.
  
  
  RESULTS
  There were 404 patients. Median levels of preoperative ionized calcium were lower in 2001-2006 compared to 1989-1994; 1.45 versus 1.50 versus 1.45 mmol/L; p < 0.001. Preoperative parathyroid hormone levels in patients with parathyroid adenoma were lower in 2001-2006 than in 1989-1994; 10.0 versus 11.6 pmol/L; p 0.04. Median preoperative bone mineral density, BMD, in the whole cohort did not differ between time periods. Median pre- and postoperative glomeruli filtration rate, GFR, and 25-hydroxy-vitamin D3 remained unchanged between period 1 and period 3. Adenoma weight was lower in 2001-2006 than 1989-1994; 0.70 versus 0.50 g; p 0.04. Cure rate did not change during observation time. There was no evidence for differences in change of BMD (femoral neck) after surgery between period 2 and 3 1995-2000 and 2001-2006, 0.798 versus 0.795 g/cm(2); p 0.67. GFR did not change significantly between 1989-1994 and 2001-2006, 74 versus 77 mL/min; p 0.43.
  
  
  CONCLUSIONS
  A significant change towards operating patients with smaller adenomas and lower preoperative calcium levels was evident throughout the observation period, but this did not correlate with differences in preoperative renal or skeletal function. We found no evidence for a change of postoperative renal function or skeletal function during observation time.
authors.affiliation: Department of Surgery, Lund University Hospital, 221 85, Lund, Sweden. mark.thier@skane.se.
authors.forename: Mark
authors.initials: M
authors.lastname: Thier
authors.affiliation: Department of Surgery, Lund University Hospital, 221 85, Lund, Sweden.
authors.forename: Erik
authors.initials: E
authors.lastname: Nordenström
authors.affiliation: Department of Surgery, Lund University Hospital, 221 85, Lund, Sweden.
authors.forename: Anders
authors.initials: A
authors.lastname: Bergenfelz
authors.affiliation: Department of Surgery, Lund University Hospital, 221 85, Lund, Sweden.
authors.forename: Martin
authors.initials: M
authors.lastname: Almquist
mesh_terms: D000236:Adenoma / Q000097:blood / Q000473:pathology / Q000601:surgery*; D000368:Aged; D015519:Bone Density; D002112:Calcifediol / Q000097:blood; D002118:Calcium / Q000097:blood; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D049950:Hyperparathyroidism, Primary / Q000097:blood* / Q000601:surgery*; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D010281:Parathyroid Hormone / Q000097:blood; D010282:Parathyroid Neoplasms / Q000097:blood / Q000473:pathology / Q000601:surgery*; D011184:Postoperative Period; D057234:Preoperative Period; D016896:Treatment Outcome; D047368:Tumor Burden
chemical_list: D010281:Parathyroid Hormone; D002112:Calcifediol; D002118:Calcium