Efficacy of parathyroidectomy compared with active surveillance in patients with mild asymptomatic primary hyperparathyr
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REVIEW
Efficacy of parathyroidectomy compared with active surveillance in patients with mild asymptomatic primary hyperparathyroidism: a systematic review and meta‑analysis of randomized‑controlled studies P. Anagnostis1,2,3 · K. Vaitsi1,2 · S. Veneti4 · V. Potoupni2,3 · E. Kenanidis2,3 · E. Tsiridis2,3 · T. S. Papavramidis4 · D. G. Goulis1,2 Received: 11 August 2020 / Accepted: 7 October 2020 © Italian Society of Endocrinology (SIE) 2020
Abstract Objective Parathyroidectomy (PTx) has an established benefit in patients with symptomatic primary hyperparathyroidism (PHPT). However, its efficacy in mild asymptomatic PHPT has not been proven. This study aimed to systematically review and meta-analyze the best available evidence from randomized-controlled trials comparing the efficacy of PTx over conservative management (non-PTx) on skeletal outcomes [fractures and bone mineral density (BMD)], nephrolithiasis risk and quality of life (QoL) in patients with mild asymptomatic PHPT. Methods A comprehensive literature search was conducted in PubMed, Scopus and Cochrane databases, from conception to February 23, 2020. Data were extracted from the studies that fulfilled the eligibility criteria and were synthesized quantitatively (fixed or random effects model) as relative risks and percentage mean differences (MD) with 95% confidence intervals (CI). I2 index was employed for heterogeneity. Results Four studies were included in the meta-analysis. There was no difference in fracture risk between PTx and active surveillance. The PTx group demonstrated higher BMD [MD 3.55% (95% CI 1.81, 5.29) in lumbar spine and 3.44% (95% CI 1.39, 5.49) in total hip, without difference in femoral neck and forearm] and lower calcium concentrations (MD − 13.26%, 95% CI − 7.10, − 19.43) compared with the non-PTx group. No difference was observed between groups regarding nephrolithiasis or QoL indices, except for general health (higher in PTx group). Conclusions In patients with mild asymptomatic PHPT, PTx increases BMD and reduces serum calcium concentrations. However, its superiority over active surveillance in terms of fracture risk, nephrolithiasis and QoL cannot be supported by current data. Keywords Parathyroidectomy · Asymptomatic primary hyperparathyroidism · Fractures · Bone mineral density · Hypercalcemia · Nephrolithiasis · Quality of life
Electronic supplementary material The online version of this article (https://doi.org/10.1007/s40618-020-01447-7) contains supplementary material, which is available to authorized users. * P. Anagnostis [email protected] 1
Unit of Reproductive Endocrinology, 1st Department of Obstetrics and Gynecology, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
Centre of Orthopedic and Regenerative Medicine Research (CORE), Center for Interdisciplinary Research and Innovation (CIRI), Aristotle University of Thessaloniki, Thessaloniki, Greece
2
3
Academic Orthopedic Unit, Aristotle University Medical School, General Hospital Papageorgiou, Thessaloniki, Gre
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