title: Parathyroidectomy for primary hyperparathyroidism in the elderly: experience of a single endocrine surgery center.
abstract: BACKGROUND
  Primary hyperparathyroidism is a common endocrine disease, and its incidence increases with age.
  
  
  OBJECTIVE
  Our aim was to retrospectively evaluate the impact of age on patient outcomes following parathyroidectomy for primary hyperparathyroidism.
  
  
  METHODS
  Two-hundred fifty-six consecutive patients undergoing parathyroidectomy with preoperative diagnosis of primary hyperparathyroidism were divided into three groups according to patient age: group A, ≤64 years; group B, 65-74 years; and group C, ≥75 years.
  
  
  RESULTS
  Thyroid disease was associated with the hyperparathyroidism in 44 patients (28.2%) in group A, 34 (44.7%) in B, and 10 (41.7%) in C (p < 0.01). Minimally invasive parathyroidectomy was performed in 104 patients (66.7%) in group A, 35 (46.1%) in B, and 8 (33.3%) in C (p < 0.01). Conversion to bilateral exploration was carried out in five cases in group A (4.6%), three in B (8.3%), and two in C (20%). Multiglandular disease was observed in six patients (3.8%) in group A, seven (9.2%) in B, and five (20.8%) in C (p = 0.012). Mean postoperative stay was similar between groups; no major complications and no cases of mortality occurred.
  
  
  CONCLUSIONS
  Multiglandular disease is more common in older patients than younger individuals, and minimally invasive approaches are less used in this patient group. Increased surgical risk and paucity of symptoms in these patients sometimes result in a delay in surgical treatment.
  
  
  CONCLUSIONS
  Parathyroidectomy is a safe and effective procedure to perform in elderly patients. Multiglandular disease was found to be more prevalent in older patients, but minimally invasive parathyroidectomy can be performed safely. Surgeons should consider parathyroidectomy in patients with primary hyperparathyroidism regardless of age.
authors.affiliation: Department of Surgical Sciences, University of Cagliari, S.S. 554, Bivio Sestu, 09042, Monserrato, CA, Italy. pgcalo@unica.it.
authors.forename: Pietro Giorgio
authors.identifier: http://orcid.org/0000-0001-9637-1145
authors.initials: PG
authors.lastname: Calò
authors.affiliation: Department of Surgical Sciences, University of Cagliari, S.S. 554, Bivio Sestu, 09042, Monserrato, CA, Italy.
authors.forename: Fabio
authors.initials: F
authors.lastname: Medas
authors.affiliation: Department of Surgical Sciences, University of Cagliari, S.S. 554, Bivio Sestu, 09042, Monserrato, CA, Italy.
authors.forename: Giulia
authors.initials: G
authors.lastname: Loi
authors.affiliation: Department of Surgical Sciences, University of Cagliari, S.S. 554, Bivio Sestu, 09042, Monserrato, CA, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Pisano
authors.affiliation: Department of Surgical Sciences, "Sapienza" University of Rome, Rome, Italy.
authors.forename: Salvatore
authors.initials: S
authors.lastname: Sorrenti
authors.affiliation: Department of Surgical Sciences, University of Cagliari, S.S. 554, Bivio Sestu, 09042, Monserrato, CA, Italy.
authors.forename: Enrico
authors.initials: E
authors.lastname: Erdas
authors.affiliation: Department of Surgical Sciences, University of Cagliari, S.S. 554, Bivio Sestu, 09042, Monserrato, CA, Italy.
authors.forename: Angelo
authors.initials: A
authors.lastname: Nicolosi
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D049950:Hyperparathyroidism, Primary / Q000000981:diagnostic imaging / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D016105:Parathyroidectomy / Q000379:methods*; D012189:Retrospective Studies; D014463:Ultrasonography
keywords: Elderly; Parathyroid; Parathyroid surgery; Parathyroidectomy; Primary hyperparathyroidism