Miriam E Tucker

May 21, 2015

Nashville, Tennessee — Parathyroidectomy in men with primary hyperparathyroidism may be associated with resolution of erectile dysfunction among those who report this condition preoperatively, a small pilot study suggests.

The association between parathyroidectomy and the resolution of erectile dysfunction has not been formally studied before but has been noted anecdotally, Jenny Y Yoo, MD, from the University of Pittsburgh, Pennsylvania, said during her presentation at the American Association of Endocrine Surgeons (AAES) 2015 Annual Meeting.

"Our intent in this pilot study was to ask a question not previously investigated and to prompt further interest in this potential relationship," Dr Yoo said.

Asked to comment, Cord Sturgeon, MD, associate professor of surgery at Northwestern University, Chicago, Illinois, told Medscape Medical News, "It's uninvestigated. It's not something that appears in the textbooks as a resolvable symptom associated with hyperparathyroidism. So, it's exciting that we're seeing for the first time some data in that arena. What it calls for is a more focused evaluation of these symptoms that are not really spoken about, that we as physicians don't understand."

However he cautioned that the data — based on self-report of symptoms and medication use — are preliminary. "When you see data like this…it makes you think we'd better study this in a prospective way with validated tools.…But I think this is something that could be important."

Erectile Dysfunction Resolved in Two-Thirds of Patients

Dr Yoo and colleagues mined a prospective database for all men with sporadic primary hyperparathyroidism who had parathyroid surgery between July 2010 and January 2014.

They used a paper review of questionnaires, with yes/no checked boxes of symptoms common to endocrine disease and general health. The surveys were administered at baseline, postoperatively, and again at 6 months. They also performed a comprehensive chart review.

Of a total 160 men with primary hyperparathyroidism who underwent parathyroidectomy, 13% had reported erectile dysfunction prior to surgery, a rate within the range of the general population.

Those 21 men were significantly older, with a mean age of 70 years vs 58 for those without erectile dysfunction (P < .01). There were no preoperative differences in mean number of symptoms or mean levels of calcium or parathyroid-hormone level. Intraoperatively, there were no differences in rates of multiglandular disease, mean resected gland weight, or percent decline in intraoperative parathyroid hormone, Dr Yoo reported.

Rates of diabetes and hypertension were similar between the two groups, but the erectile-dysfunction patients were taking more blood-pressure medications (mean, 1.8 vs 1.1; P = .01).

Of the 21 who had self-reported erectile dysfunction prior to surgery, 14 (67%) did not document it on the questionnaire 6 months later.

Comparing the 14 men whose erectile dysfunction resolved with the seven in whom it persisted, there were no preoperative differences in mean age, diabetes, hypertension, mean number of symptoms, or mean number of blood-pressure medications.

However, those with erectile-dysfunction resolution had significantly lower mean arterial blood pressures, 96.6 vs 105.4 mm Hg (P = .03).

There were no differences between those in whom erectile dysfunction did and didn't resolve in preoperative calcium, mean parathyroid hormone, vitamin D, intraoperative percent decline in intraoperative parathyroid hormone, resected gland weight, or multiglandular disease. Postoperatively, there were no differences in mean calcium, number of symptoms, or mean arterial pressure.

There were no differences between groups in quality-of-life measures, but two of eight who had reported depressed mood prior to surgery had improved mood after surgery (P = .33).

Only two patients reported taking erectile-dysfunction medications prior to surgery and had stopped the medication by 6 months postsurgery.

In a control group of 132 age-matched patients who underwent thyroidectomy during the study period, 10 of 23 (43%) who reported erectile dysfunction preoperatively did not report it afterward.

This is lower than the 67% of postparathyroidectomy patients reporting erectile-dysfunction resolution (P = .13), Dr Yoo noted.

She acknowledged that the numbers in her study were small, but there's a good reason for that: Most primary-hyperparathyroidism patients are women. "Further prospective, multicenter studies with standardized erectile-dysfunction assessment tools would be optimal," she concluded.

Drs Yoo and Sturgeon have reported no relevant financial relationships.

American Association of Endocrine Surgeons (AAES) 2015 Annual Meeting. May 18, 2015; Nashville, Tennessee. Abstract 9.


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