Primary hyperparathyroidism treatments and disease prognosis ; single center experience

Primary hyperparathyroidism (PHPT) is a frequently seen endocrine disorder which causes overproduction of parathormone (PTH) from parathyroid tissues. In the last three decades early diagnosed, asymptomatic PHPT has taken place of late diagnosed, classic PHPT with severe complications. While surgery is the curative therapy of the disease there is a dynamic discussion going on for last 15 years about concerning the timing of the operation for asymptomatic patients. 171 patients, all aged above 18 years, diagnosed with PHPT during 2005-2015 in Baskent University Ankara Hospital were enrolled into our study. Data regarding patients' serum PTH, calcium, phosphorus, creatinine and urinary calcium levels, bone mineral density (BMD) scores, indications for surgery, pathology results, compatibility of pre-operative imaging techniques, complications, medical therapies and outcomes were obtained. Laboratory datas of patients with an interval of at least three months were examined. Mean age of disease was calculated as 62 (±13.07) years. The disease was shown to be predominant in females with the male-female ratio of 1:3. Patients then grouped, and changes in laboratory and clinic parameters were compared. Patients presented with classic disease, had significant decrease in serum PTH (at the time of diagnosis 153.6±146,0 pg/mL, at the end of therapy 86.5±50.6 pg/mL) and calcium (at the time of diagnosis10.4±0.8 mg/dL, at the end of therapy 9.8±0.7 mg/dL) levels. Patients fulfilling indication of surgery, but weren't operated for whether severe comorbidities or not giving consents showed no significant improvement regarding laboratory data. However patients who underwent surgery showed significant improvements in serum PTH (at the time of diagnosis 200.5±204 pg/mL; at the end of therapy 70.7±50.87 pg/mL), calcium (at the time of diagnosis 11.1±1.1 mg/dL; at the end of therapy 9.3±0.6 mg/dL) and phosphorus (at the time of diagnosis 2.9±0.5 mg/dL; at the end of therapy 3.4±0.6 mg/dL) levels (p<0.001). These results showed the importance of surgery for the curative therapy. A subset of patients who did not undergo surgery (25 patients) were treated with medical therapy (bisphosphonates, cinacalset, diuretics etc.). These patients showed significant improvement in urinary calcium excretion (at the time of diagnosis 239.06±135.3 mg/day at the end of therapy 193.36±116.0 mg/day) (p<0.001). However no significant improvement was observed in any other parameter. Relatively small number of the patient population may have caused this result. A more serious complication of the disease is its destructive effects on bone tissue. In our study we did not observe any significant improvement in BMD scores. However we speculate this stems from insufficiency of follow-ups and data collecting in regard to BMD scores rather than the failure of therapy. In the light of the guidelines, BMD evaluations should be conducted more frequently by clinicians. Trials with more patients and with longer follow-up are needed for PHPT