Open AccessProspective case–control analysis of treatment of menopausal primary hyperparathyroidism: calcium and parathyroid hormone
Author(s) -
Lundgren E.,
Naessen T.,
Ljunghall S.,
Rastad J.
Publication year - 2000
Publication title -
british journal of surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.202
H-Index - 201
eISSN - 1365-2168
pISSN - 0007-1323
DOI - 10.1046/j.1365-2168.2000.01601-15.x
Subject(s) - medicine , primary hyperparathyroidism , parathyroidectomy , parathyroid hormone , asymptomatic , calcium metabolism , prospective cohort study , urology , hyperparathyroidism , population , calcium , urinary calcium , surgery , vitamin d and neurology , secondary hyperparathyroidism , gastroenterology , endocrinology , environmental health
Background Therapeutic options in primary hyperparathyroidism (HPT) have not been analysed in postmenopausal women recruited by population‐based screening. Methods Postmenopausal women ( n = 92) with HPT detected at population‐based screening entered into a prospective case–control comparison at mean(s.d.) 66·5(6·0) years of age. Biochemical signs of HPT were mild (mean(s.d.) serum calcium 2·59(0·14) mmol l −1 ) and cases were considered overtly asymptomatic. Parathyroid surgery, oestrogen replacement therapy (ERT; ethinyloestradiol), ERT and surgery, and conservative surveillance were evaluated after 1, 2 and 5 years. Follow‐up was complete in 75 per cent of the patients. Results Parathyroid surgery rendered the total and ionized calcium, and intact parathyroid hormone (PTH) values in blood, and the urinary calcium excretion indistinguishable between cases and controls. ERT was maintained during approximately 80 per cent of the follow‐up period. It reduced the blood calcium levels significantly and tended to increase the serum PTH level. Significant discrepancies, however, persisted towards the controls. ERT added no significant changes to the biochemical outcome of parathyroidectomy. Conservatively treated cases had essentially stable parameters over the study period. Conclusion Parathyroidectomy was the only treatment option that normalized basic variables of the calcium homoeostasis to control levels in postmenopausal women with mild primary HPT. © 2000 British Journal of Surgery Society Ltd