title: Comparative efficacy of parathyroidectomy and active surveillance in patients with mild primary hyperparathyroidism: a systematic review and meta-analysis.
abstract: Counseling for patients with primary hyperparathyroidism (PHPT) and mild hypercalcemia without indications for surgical intervention requires accurate estimates of the potential benefits of parathyroidectomy. We aim to summarize the available evidence regarding the benefits of parathyroidectomy that patients with mild PHPT without indications for surgery experience compared to observation. We searched multiple databases from inception to August 2015. We included randomized controlled trials (RCT) and observational studies that evaluated changes in bone health, quality of life or neuropsychiatric symptoms, or in the risk of nephrolithiasis, cardiovascular events, or death between patients undergoing parathyroidectomy or active surveillance. Eight studies were eligible. Risk differences were not significant, in part due to lack of events (fractures, nephrolithiasis, cardiovascular events, or deaths). No significant differences were observed across measures of bone health, quality of life, and neuropsychiatric symptoms. A single RCT evaluating bone mineral density (BMD) changes at 5 years found a small statistically significant effect favoring parathyroidectomy. Patients with mild PHPT without indications for surgery experience a limited number of adverse consequences during short-term follow-up limiting our ability to estimate the benefit of surgery during this timeframe. This information is helpful as these patients consider surgery versus active surveillance. Long-term data is warranted to determine who benefits in the long run from surgical intervention and the extent to which this benefit affects outcomes that matter to patients.
authors: Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Knowledge and Evaluation Research Unit, Mayo Clinic College of Medicine, 200 First St. SW, Rochester, MN, 55905, USA.|Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN, USA.
authors: N
authors: N
authors: Singh Ospina
authors: Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Knowledge and Evaluation Research Unit, Mayo Clinic College of Medicine, 200 First St. SW, Rochester, MN, 55905, USA.|Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN, USA.
authors: S
authors: S
authors: Maraka
authors: Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN, USA.|Endocrinology Division, Department of Internal Medicine, University Hospital Dr. Jose E. Gonzalez, Monterrey, Mexico.
authors: R
authors: R
authors: Rodriguez-Gutierrez
authors: Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Knowledge and Evaluation Research Unit, Mayo Clinic College of Medicine, 200 First St. SW, Rochester, MN, 55905, USA.
authors: A E
authors: AE
authors: Espinosa de Ycaza
authors: Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Knowledge and Evaluation Research Unit, Mayo Clinic College of Medicine, 200 First St. SW, Rochester, MN, 55905, USA.
authors: S
authors: S
authors: Jasim
authors: Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN, USA.|Mayo Graduate School, Mayo Clinic, Rochester, MN, 55905, USA.
authors: M
authors: M
authors: Gionfriddo
authors: Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN, USA.|Unidad de Conocimiento y Evidencia, Universidad Peruana Cayetano Heredia, Lima, Peru.
authors: A
authors: A
authors: Castaneda-Guarderas
authors: Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Knowledge and Evaluation Research Unit, Mayo Clinic College of Medicine, 200 First St. SW, Rochester, MN, 55905, USA.|Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN, USA.
authors: J P
authors: JP
authors: Brito
authors: Division of Pediatric Endocrinology and Metabolism, Mayo Clinic, Rochester, MN, USA.|Sanford Children's specialty Clinic, Sioux Falls, SD, USA.
authors: A
authors: A
authors: Al Nofal
authors: Mayo Medical Libraries, Mayo Clinic, Rochester, MN, 55905, USA.
authors: P
authors: P
authors: Erwin
authors: Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Knowledge and Evaluation Research Unit, Mayo Clinic College of Medicine, 200 First St. SW, Rochester, MN, 55905, USA.
authors: R
authors: R
authors: Wermers
authors: Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Knowledge and Evaluation Research Unit, Mayo Clinic College of Medicine, 200 First St. SW, Rochester, MN, 55905, USA. Montori.Victor@mayo.edu.|Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN, USA. Montori.Victor@mayo.edu.
authors: V
authors: V
authors: Montori
mesh_terms: D015519:Bone Density; D006801:Humans; D006934:Hypercalcemia / Q000150:complications; D049950:Hyperparathyroidism, Primary / Q000601:surgery*; D064887:Observational Studies as Topic; D016105:Parathyroidectomy; D011788:Quality of Life
keywords: Bone mineral density; Hypercalcemia; Parathyroidectomy; Primary hyperparathyroidism; Surveillance