Journal
JOURNAL OF CLINICAL MEDICINE
Volume 12, Issue 19, Pages -Publisher
MDPI
DOI: 10.3390/jcm12196321
Keywords
primary hyperparathyroidism; elderly; prevalence; clinical manifestations; medical management; surgery; complications
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This review sheds light on primary hyperparathyroidism (PHPT) in older adults, including its prevalence, clinical manifestations, management options, and post-operative complications. The prevalence of PHPT in the elderly is approximately 1%, with female predominance. Clinical symptoms vary with age and may include osteoporosis, fractures, and neuropsychiatric symptoms. Parathyroidectomy (PTX) has been demonstrated to be a safe and effective treatment option in the older population, improving symptoms and quality of life.
Background: Primary hyperparathyroidism (PHPT) is a common endocrine disorder among older adults. The aim of this review is to shed light on PHPT, particularly in this age group, in terms of prevalence, clinical manifestations, medical and surgical management, and post-operative complications. Methods: Eligible studies were those considering PHPT exclusively in the older population (main databases: PubMed, Medline, Google Scholar and the University Online database). Articles published in the last 10 years (2013-2023) were considered. Eligibility criteria followed the SPIDER (sample, phenomenon of interest, design, evaluation, research type) tool. The methodological quality of the studies was assessed using the Joanna Briggs Institute critical appraisal tool. A total of 29 studies (mainly observational) matched the inclusion criteria. Results: The prevalence of PHPT is approximately 1 per 100 in the elderly, and it is more common in females. The clinical presentation varies by age and can include osteoporosis, fractures, and neuropsychiatric symptoms. Conservative management can be an option whenever surgery is not indicated or feasible. However, parathyroidectomy (PTX) remains a safe and effective modality in aging populations with improvement to symptoms, bone mineral density, fracture risk, frailty, quality of life, and metabolic derangements. Complication rates are similar in elderly people compared to younger ones, except for mildly longer length of hospital stay and reoperation for those with higher frailty. Conclusion: PHPT is a common yet overlooked and underdiagnosed condition among the older population. The safety and efficacy of PTX in the older population on different levels is now well demonstrated in the literature.
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