Abstract
To investigate long-term survival after operation for primary hyperparathyroidism, a follow-up study was performed on 896 consecutive patients in whom this diagnosis had been clinically and microscopically verified. These patients were operated on in the years 1953–1982. Their mean age at operation was 57.3 years [standard deviation (SD) 13.1], overall cure rate was 97.0%, and postoperative mortality was 0.89%. Follow-up was 99.8% complete by the end of 1986. Mean follow-up time was 12.9 years (SD: 6.1). Two-hundred ninety-four patients were deceased, which was 118 more than in a control group (p<0.001). The latter was based on Swedish population statistics, matched for age, sex, and calendar year. Each year, the control group was the same size as the hyperparathyroid population. The risk of premature death remained increased (p<0.001) even after exclusion of poor-risk patients having their hyperparathyroidism diagnosed when being treated or followed because of other serious diseases. The main causes of premature death for the hyperparathyroid patients were cardiovascular and malignant diseases. Both occurred more often than in the control group (p<0.001). The results demonstrate that primary hyperparathyroidism causes damage that is not reversed by surgery.
Résumé
Pour évaluer la survie à long terme après opération pour hyperparathyroÏdie primaire, le devenir de 896 patients chez lesquels ce diagnostic avait été clinquement posé et vérifié histologiquement a été analysé. Ces patients ont été opérés entre 1953 et 1982. L'âge moyen au moment de l'intervention était de â 57.3 ans (ET: 13.1), le taux global de cure était de 97.0%, la mortalité post-opératoire était de 0.89%. Le suivi était complet à 99.8% à la fin de l'année 1986. Le suivi moyen était de 12.9 ans (ET: 6.1). Deux cent quatre vingt quatorze patients sont morts, 118 de plus que dans le groupe contrôle (p<0.001), basé sur les statistiques suédoises d'une population composée de sujets comparables du point de vue âge, sexe, et année de mort. Le groupe de contrôle était de la mÊme taille pour chaque année que pour la population hyperparathyroÏde. Le risque de mort précoce chez les patients hyperparathyroÏdes était augmenté (p<0.001) mÊme après exclusion des patients à haut risque dont l'hyperparathyroÏdie avait été diagnostiquée pendant le traitement d'une autre maladie grave. Les principales causes de mort précoce chez le patient hyperparathyroÏdien étaient soit une maladie cardiovasculaire, soit une maladie maligne. Les deux étaient plus fréquentes que dans le groupe de contrôle (p<0.001). Ces résultats démontrent que l'hyperparathyrodie est responsable de lésions qui ne sont pas réversibles après cure de l'hyperparathyroÏdie.
Resumen
Con el fin de investigar la sobrevida a largo plazo después del tratamiento quirÚrgico del hiperparatiroidismo primario, se realizó un estudio de seguimiento en 896 pacientes consecutivos en los cuales se comprobó el diagnóstico por la clínica y por métodos microscópicos. Estos pacientes fueron operados en el período 1953–1982. Le edad promedio en el momento de la operación fue 57.3 años (DE: 13.1), la tasa global de curación 97.0%, y la mortalidad postoperatoria 0.89%. El seguimiento fue completo en el 99.8% de los casos hasta el final de 1986. El promedio de tiempo de seguimiento fue de 12.9 años (DE: 6.1); 294 pacientes murieron, cifra que fue 118 personas, mayor que en el grupo control (p<0.001), el cual se basó en estadísticas suecas para una población similar en cuanto a edad, sexo, y años calendario.
El grupo control fue cada año del mismo volumen que el de la población hiperparatiroidea. El riesgo de muerte prematura se mantuvo aumentado (p<0.001) aun después de excluir los pacientes de alto riesgo en los cuales se diagnosticó el hiperparatiroidismo mientras estaban bajo tratamiento por otras enfermedades serias. Las causas de muerte prematura principal en los pacientes hiperparatiroideos fueron las enfermedades cardiovasculares y las neoplasias malignas; ambas se presentaron con mayor frecuencia que en el grupo control (p<0.001). Los resultados demuestran que el hiperparatiroidismo primario causa lesiones que no revierten con la cirugía.
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References
Ronni-Sivula, H.: Causes of death in patients previously operated on for primary hyperparathyroidism. Ann. Chir. Gynaecol.74:13, 1984
Palmér, M., Adami, H.O., Bergström, R., åkerström, G., Ljunghall, S.: Mortality after surgery for primary hyperparathyroidism. A follow-up of 441 patients operated on from 1956 to 1979. Surgery102:1, 1987
Kaplan, L., Katz, A.D., Ben-Isaac, C., Massry, S.G.: Malignant neoplasms and parathyroid adenoma. Cancer8:401, 1971
Wajngot, A., Werner, S., Granberg, P.O., Lindvall, N.: Occurrence of pituitary adenomas and other neoplastic disorders in primary hyperparathyroidism. Surg. Gynecol. Obstet.151:401, 1980
Palmér, M., Adami, H.O., Krusemo, U.B., Ljunghall, S.: Increased risk of malignant diseases after operation for primary hyperparathyroidism: A nation wide cohort study. Am. J. Epidemiol.127:1031, 1988
Jansson, S., Tisell, L.E.: Autotransplantation of diseased parathyroid glands into subcutaneous abdominal adipose tissue. Surgery100:549, 1987
Hedman, I., Tisell, L.E.: Autotransplantation of fresh diseased parathyroid tissue in primary and radiation-induced hyperparathyroidism. Am. J. Surg.143:614, 1982
Department of Statistics on causes of death in Sweden, SCB, National Central Bureau of Statistics in Sweden, Stockholm, Sweden
SCB, National Central Bureau of Statistics in Sweden: Classification of deaths in Swedish statistics according to WHO, 8th revision of International Classification of Deaths, ICD, Stockholm, May, 1987
SCB, National Central Bureau of Statistics in Sweden: Causes of death. Annual publ. 1961–1985, tables according to sex and age, detail list, Stockholm, 1987
SCB, National Central Bureau of Statistics in Sweden: Population changes III. Sex and age specified table on mean population. Annual publ. 1961–1985, Stockholm, 1987
Bruining, H.A., van Houten, H., Juttman, J.R., Lamberts, S.W.J., Birkenhäger, J.C.: Results of operative treatment of 615 patients with primary hyperparathyroidism. World. J. Surg.5:85, 1981
Attie, N.J., Khafif, R.A.: Surgical exploration in asymptomatic hypercalcemia. Am. J. Surg.132:449, 1976
Coffey, R.J., Lee, T.C., Canary, J.J.: The surgical treatment of primary hyperparathyroidism: A 20 year experience. Ann. Surg.185:518, 1977
Russell, C.F., Edis, A.J.: Surgery for primary hyperparathyroidism, experience with 500 consecutive cases and evaluation of the role of surgery in the asymptomatic patient. Br. J. Surg.69:244, 1982
Trigonis, C., Hamberger, B., Farnebo, L.O., Abarca, J., Granberg, P.O.: Primary hyperparathyroidism, changing trends over fifty years. Acta Chir. Scand.149:675, 1983
Gaz, R.D., Wang, C.: Management of asymptomatic hyperparathyroidism. Am. J. Surg.147:498, 1984
Palmér, M., Ljunghall, S., åkerström, G., Adami, H.O., Bergström, R., Grimelius, L., Rudberg, C., Johansson, H.: Patients with primary hyperparathyroidism operated on over a 24 year period: Temporal trends of clinical and laboratory findings. J. Chronic Dis.40:121, 1987
de Faire, U., Friberg, L., Lorich, U., Lundman, T.: A Validation of cause-of-death certification in 1156 deaths. Acta Med. Scand.200:223, 1976
Christensson, T., Hellström, K., Wengle, B.: Blood pressure in subjects with hypercalcemia and primary hyperparathyroidism detected in a health screening program. Eur. J. Clin. Invest.7:109, 1977
Lafferty, F.W.: Primary hyperparathyroidism. Changing clinical spectrum, prevalence of hypertension and discriminant analysis of laboratory tests. Arch. Int. Med.141:1761, 1981
Ljunghall, S., Lithell, H., Vessby, B., Wide, L.: Glucose and lipoprotein metabolism in primary hyperparathyroidism. Acta Endocrinol.89:580, 1978
Symons, C., Fortune, F., Greenbaum, R.A., Dandona, P.: Cardiac hypertrophic cardiomyopathy and hyperparathyroidism—An association. Br. Heart J.54:529, 1985
McCarron, D.A., Pingree, P.A., Robin, R.J., Gaucher, S.M., Molitch, M., Krutzik, S.: Enhanced parathyroid function in essential hypertension. Hypertension2:162, 1980
McCarron, D.A.: Low serum concentration of ionized calcium in patients with hypertension. N. Engl. J. Med.4:226, 1982
Strazzullo, P., Nunziata, V., Cirillo, M., Giannattasio, R., Ferrara, L.A., Mattioli, P.L., Mancini, M.: Abnormalities of calcium metabolism in essential hypertension. Clin. Sci.65:137, 1983
Daniels, J., Goodman, A.D.: Hypertension and hyperparathyroidism. Inverse relation of serum phosphate level and blood pressure. Am. J. Med.75:17, 1983
Perris, A.D., MacManus, J.P., Whitfield, J.F., Weiss, L.A.: Parathyroid glands and mitotic stimulation in rat bone marrow after hemorrhage. Am. J. Physiol.220:773, 1971
Elias, A.N., Sharma, B.S., Stokes, J.D., Valenta, L.J.: Immunological aberration in primary hyperparathyroidism. Acta Endocrinol.101:47, 1982
Christensson, T.: Menopausal age of females with hypercalcaemia. Acta Med. Scand.200:361, 1976
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Supported by grants from the Göteborg Medical Society, the University of Göteborg, the King Gustav V Jubilee Clinic Research Foundation, and from the Swedish Medical Research Council (06534).
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Hedbäck, G., Tisell, LE., Bengtsson, Bå. et al. Premature death in patients operated on for primary hyperparathyroidism. World J. Surg. 14, 829–835 (1990). https://doi.org/10.1007/BF01670531
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DOI: https://doi.org/10.1007/BF01670531