Log in to MyACC
Mortality and Morbidity in Mild Primary Hyperparathyroidism
Quick Takes
- Parathyroidectomy for mild primary hyperparathyroidism was not associated with an increased risk for death.
- No difference between groups (parathyroidectomy or observation) was noted for cardiovascular events.
Study Questions:
Does parathyroidectomy for mild primary hyperparathyroidism influence mortality?
Methods:
The SIPH (Scandinavian Investigation of Primary Hyperparathyroidism) study was a prospective, randomized, controlled trial conducted in eight Scandinavian referral centers (four in Sweden, three in Norway, and one in Denmark) between 1998 and 2005. The study had a preplanned 10-year follow-up with annual visits, the last completed in June 2017. Patients with mild hyperparathyroidism were included. Mortality, including date and cause, was obtained through the Swedish and Norwegian Cause of Death Registries 10 years after randomization and after an extended observation period lasting until 2018. During the study period, 23 patients in the parathyroidectomy group and 27 in the observation group withdrew.
Results:
A total of 191 patients with mild primary hyperparathyroidism were randomized to parathyroidectomy (n = 95) or observation (n = 96). After 10 years, 15 patients had died (eight in the parathyroidectomy group and seven in the observation group; hazard ratio [HR], 1.17; 95% confidence interval [CI], 0.43-3.24; p = 0.76) for the parathyroidectomy group compared with the observation group. Within the extended observation period, 44 deaths (23%) occurred, which were evenly distributed between groups (24 in the parathyroidectomy group and 20 in the observation group). The mean age of the surviving patients at the end of this observation period was 77.0 years (standard deviation [SD], 6.65) for the Swedish patients and 77.3 years (SD, 6.41) for the Norwegian patients. A total of 101 morbidity events (cardiovascular events, cerebrovascular events, cancer, peripheral fractures, and renal stones) were also similarly distributed between groups (52 in the parathyroidectomy group and 49 in the observation group). The HR for death in the parathyroidectomy group was 1.23 (CI, 0.68-2.23; p = 0.68) compared to the observation group. During the study, a total of 16 vertebral fractures occurred in 14 patients (seven in each group).
Conclusions:
In this trial, the investigators concluded that parathyroidectomy does not appear to reduce morbidity or mortality in mild primary hyperparathyroidism.
Perspective:
Compared to observation, parathyroidectomy for mild primary hyperparathyroidism was not associated with an increased risk of cardiovascular events. These data suggest that increased calcium due to mild primary hyperparathyroidism is not associated with an increased risk for cardiovascular events or mortality.
Clinical Topics: Cardiovascular Care Team, Geriatric Cardiology, Prevention
Keywords: Calcium, Cardiovascular Diseases, Fractures, Bone, Geriatrics, Hyperparathyroidism, Hyperparathyroidism, Primary, Morbidity, Neoplasms, Parathyroidectomy, Primary Prevention
< Back to Listings
