Iperparatiroidismo primitivo. Analisi critica di un'esperienza di 20 anni (Primary hyperparathyroidism. A 20-year experience and a critical review)

PURPOSE: The aim of this study was to review our 20-year experience in the treatment of primary hyperparathyroidism (HPT) and to analyze clinical and biochemical findings in patients surgically treated in the nineties and before. MATERIAL AND METHODS: From 1978 to 1997, 302 patients with proved HPT underwent primary surgery. There were 95 (31.5%) males and 207 (68.5%) females with a median age of 53 years (range 11-82 years). Two groups of patients were considered: Group 1 (156 patients undergoing surgery between 1978 and 1989) and Group 2 (146 patients undergoing surgery from 1990 to 1997). RESULTS: No differences (p = NS) were found regarding age at operation and preoperative serum creatinine values. The most frequent symptoms in both groups were of rheumatological nature (54.5% and 42.5% in Groups 1 and 2 respectively). Renal stones were described in 60.3% and 42.5% of Group 1 and 2 patients, while peptic ulcerations or gastritis were present in 25.0% and 15.1%. No differences (p = NS) in the number of patients with neurological and neuropsychiatric rate and in the median size of the removed parathyroid glands were observed between the two groups. Asymptomatic HPT was more frequent (20.5% vs 7.7%) in patients who underwent parathyroidectomy from 1990. Average serum calcium preoperative levels and delayed diagnosis were greater (p < 0.01) in Group 1 (3.10 vs 2.90 mmol/L and 72 vs 24 months respectively). CONCLUSION: Increase of asymptomatic patients with HPT allowing an earlier surgical treatment may reduce the time of the of neck exploration and morbidity rate.