26MANAGEMENT OF PRIMARY HYPERPARATHYROIDISM (PHPT) IN OLDER PEOPLE: A SERIES REVIEW

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Abstract

Introduction: Primary hyperparathyroidism is a common cause of hypercalcemia in older people. Surgery is generally recommended to prevent end organ damage. However it is not the favoured treatment for many older people due to co morbidities. We describe our experience with medical treatment of PHPT in older patients for a period of up to 7 years.

Method: Our database showed 12 patients with PHPT. Following data were extracted: Demographics, serial serum calcium levels pre and post treatment, serum creatinine and parathyroid hormone levels, hyperparathyroid/ hypercalcemic crisis, fracture details, duration and frequency of follow up, comorbidities and treatment choice.

Results: - All patients were female, mean age was 84 yrs and mean duration of follow up was 3.5 yrs (range 7 yrs)

- Sodium clodronate (between 800mg and 3200mg per day) adequately controlled serum calcium level - mean pre-treatment calcium 2.9mmol/l and mean post treatment calcium 2.5mmol/L

- One patient did not require any treatment (intermittent mild hypercalcemia)

- Renal function remained unaltered in 11

- Fractures occurred in 5 patients and 4 of them were prior to commencement of treatment

- 1 underwent parathyroidectomy due to persistent hypercalcemia

- During the follow up period 6 patients died, none of the death was due to parathyroid related aetiology

- Success rate with medical treatment of PHPT was 91%

Conclusion: This study shows that hypercalcemia and end organ damages in PHPT can be successfully treated with medications in older people as long as appropriate monitoring strategies are adopted according to their comorbidities.

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