A 10-year prospective study of primary hyperparathyroidism with or withoutparathyroid surgery

Background In the United States, most patients with primary hyperparathyroi dism have few or no symptoms. The need for parathyroidectomy to treat all p atients with this disorder has therefore been questioned. Methods We studied the clinical course and development of complications for periods of up to 10 years in 121 patients with primary hyperparathyroidism , 101 (83 percent) of whom were asymptomatic. There were 30 men and 91 wome n (age range, 20 to 79 years). During the study, 61 patients (50 percent) u nderwent parathyroidectomy, and 60 patients were followed without surgery. Results Parathyroidectomy in patients with or without symptoms led to norma lization of serum calcium concentrations and a mean (+/-SE) increase in lum bar-spine bone mineral density of 8+/-2 percent after 1 year (P=0.005) and 12+/-3 percent after 10 years (P=0.03). Bone mineral density of the femoral neck increased 6+/-1 percent after 1 year (P=0.002) and 14+/-4 percent aft er 10 years (P=0.002). Bone mineral density of the radius did not change si gnificantly. The 52 asymptomatic patients who did not undergo surgery had n o change in serum calcium concentration, urinary calcium excretion, or bone mineral density. However, 14 of these 52 patients (27 percent) had progres sion of disease, defined as the development of at least one new indication for parathyroidectomy. All 20 patients with symptoms had kidney stones. Non e of the 12 who underwent parathyroidectomy had recurrent kidney stones, wh ereas 6 of the 8 patients who did not undergo surgery did have a recurrence . Conclusions In patients with primary hyperparathyroidism, parathyroidectomy results in the normalization of biochemical values and increased bone mine ral density. Most asymptomatic patients who did not undergo surgery did not have progression of disease, but approximately one quarter of them did hav e some progression. (N Engl J Med 1999;341:1249-55.) (C)1999, Massachusetts Medical Society.