Purpose: Evaluation of the phenotype of primary hyperparathyroidism (PHPT), adherence to International Guidelines for parathyroidectomy (PTx), and rate of surgical cure. Method: From January 2014–January 2016, we performed a prospective, multicenter study in patients with newly diagnosed PHPT. Biochemical and instrumental data were collected at baseline and during 1-year follow-up.Results: Over the first year we enrolled 604 patients (age 61 ± 14 years), mostly women (83%), referred for further evaluation and treatment advice. Five hundred sixty-six patients had sporadic PHPT (93.7%, age 63 ± 13 years), the remaining 38 (6.3%, age 41 ± 17 years) had familial PHPT. The majority of patients (59%) were asymptomatic. Surgery was advised in 281 (46.5%). Follow-up data were available in 345 patients. Eighty-seven of 158 (55.1%) symptomatic patients underwent PTx. Sixty-five (53.7%) of 121 asymptomatic patients with at least one criterion for surgery underwent PTx and 56 (46.3%) were followed without surgery. Negative parathyroid imaging studies predicted a conservative approach [symptomatic PHPT: OR 18.0 (95% CI 4.2–81.0) P < 0.001; asymptomatic PHPT: OR 10.8, (95% CI 3.1–37.15) P < 0.001). PTx was also performed in 16 of 66 (25.7%) asymptomatic patients without surgical criteria. Young age, serum calcium concentration, 24 h urinary calcium, positive parathyroid imaging (either ultrasound or MIBI scan positive in 75% vs. 16.7%, P = 0.001) were predictors of parathyroid surgery. Almost all (94%) of patients were cured by PTx. Conclusions: Italian endocrinologists do not follow guidelines for the management of PHPT. Negative parathyroid imaging studies are strong predictors of a non-surgical approach. PTx is successful in almost all patients.

Clinical presentation and management of patients with primary hyperparathyroidism in Italy / Saponaro, F.; Cetani, F.; Repaci, A.; Pagotto, U.; Cipriani, C.; Pepe, J.; Minisola, S.; Cipri, C.; Vescini, F.; Scillitani, A.; Salcuni, A.; Palmieri, S.; Eller-Vainicher, C.; Chiodini, I.; Madeo, B.; Kara, E.; Castellano, E.; Borretta, G.; Gianotti, L.; Romanelli, F.; Camozzi, V.; Faggiano, A.; Corbetta, S.; Cianferotti, L.; Brandi, M. L.; de Feo, M. L.; Palermo, A.; Vezzoli, G.; Maino, F.; Scalese, M.; Marcocci, C.. - In: JOURNAL OF ENDOCRINOLOGICAL INVESTIGATION. - ISSN 0391-4097. - 41:11(2018), pp. 1339-1348. [10.1007/s40618-018-0879-z]

Clinical presentation and management of patients with primary hyperparathyroidism in Italy

Cipriani, C.;Pepe, J.;Minisola, S.;Castellano, E.;Romanelli, F.;Faggiano, A.;Brandi, M. L.;
2018

Abstract

Purpose: Evaluation of the phenotype of primary hyperparathyroidism (PHPT), adherence to International Guidelines for parathyroidectomy (PTx), and rate of surgical cure. Method: From January 2014–January 2016, we performed a prospective, multicenter study in patients with newly diagnosed PHPT. Biochemical and instrumental data were collected at baseline and during 1-year follow-up.Results: Over the first year we enrolled 604 patients (age 61 ± 14 years), mostly women (83%), referred for further evaluation and treatment advice. Five hundred sixty-six patients had sporadic PHPT (93.7%, age 63 ± 13 years), the remaining 38 (6.3%, age 41 ± 17 years) had familial PHPT. The majority of patients (59%) were asymptomatic. Surgery was advised in 281 (46.5%). Follow-up data were available in 345 patients. Eighty-seven of 158 (55.1%) symptomatic patients underwent PTx. Sixty-five (53.7%) of 121 asymptomatic patients with at least one criterion for surgery underwent PTx and 56 (46.3%) were followed without surgery. Negative parathyroid imaging studies predicted a conservative approach [symptomatic PHPT: OR 18.0 (95% CI 4.2–81.0) P < 0.001; asymptomatic PHPT: OR 10.8, (95% CI 3.1–37.15) P < 0.001). PTx was also performed in 16 of 66 (25.7%) asymptomatic patients without surgical criteria. Young age, serum calcium concentration, 24 h urinary calcium, positive parathyroid imaging (either ultrasound or MIBI scan positive in 75% vs. 16.7%, P = 0.001) were predictors of parathyroid surgery. Almost all (94%) of patients were cured by PTx. Conclusions: Italian endocrinologists do not follow guidelines for the management of PHPT. Negative parathyroid imaging studies are strong predictors of a non-surgical approach. PTx is successful in almost all patients.
2018
parathyroid adenoma; parathyroid imaging; parathyroidectomy; serum calcium; endocrinology, diabetes and metabolism; endocrinology
01 Pubblicazione su rivista::01a Articolo in rivista
Clinical presentation and management of patients with primary hyperparathyroidism in Italy / Saponaro, F.; Cetani, F.; Repaci, A.; Pagotto, U.; Cipriani, C.; Pepe, J.; Minisola, S.; Cipri, C.; Vescini, F.; Scillitani, A.; Salcuni, A.; Palmieri, S.; Eller-Vainicher, C.; Chiodini, I.; Madeo, B.; Kara, E.; Castellano, E.; Borretta, G.; Gianotti, L.; Romanelli, F.; Camozzi, V.; Faggiano, A.; Corbetta, S.; Cianferotti, L.; Brandi, M. L.; de Feo, M. L.; Palermo, A.; Vezzoli, G.; Maino, F.; Scalese, M.; Marcocci, C.. - In: JOURNAL OF ENDOCRINOLOGICAL INVESTIGATION. - ISSN 0391-4097. - 41:11(2018), pp. 1339-1348. [10.1007/s40618-018-0879-z]
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11573/1114934
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