SHOULD PRIMARY HYPERPARATHYROIDISM BE TREATED SURGICALLY IN ELDERLY PATIENTS OLDER THAN 75 YEARS

Background. Diagnosis of primary hyperparathyroidism (PHPT) is increasingly suspected in elderly patients after the discovery of hypercalcemia by routine measurement of serum calcium levels. Surgery is commonly accepted as the optimal treatment of PHPT. We wanted to assess rick and results of neck exploration in elderly patients with PHPT. Methods. We performed a retrospective study of the charts of 78 patients older than 75 years (mean age, 79.1 years) with PHPT who underwent neck exploration during a 15-year period. Results. The most common presenting symptoms were neurologic and psychiatric disorders (47 patients). Peroperative localization investigations, performed in 72 patients, were successful in 42 of them (sensivity, 58%). Single adenoma, double adenomas, and hyperplasia were found in 74 patients (95%), three patients, and one patient, respectively. Overall postoperative mortality was 3.8% (three patients) with no death since 1984. Significant complications occurred in three patients (4%): one myocardial infraction, one pulmonary embolism, and one cerebral hemorrhage. Average length of postoperative hospital stay was 4 days. Among patients who could be followed up (65 cases with a mean follow-up of 3 years), 94% reported an improvement in their symptoms. This was especially marked for fatigue and intellectual function. Conclusions. These data support a liberal approach regarding surgical treatment in elderly patients with PHPT.