Clinical Presentation of Primary Hyperparathyroidism in Older Adults

Elena Castellano; Roberto Attanasio; Alberto Boriano; Giorgio Borretta


J Endo Soc. 2019;3(12):2305-2312. 

In This Article

Abstract and Introduction


Background: The clinical presentation of primary hyperparathyroidism (PHPT) has changed greatly during the past few decades. Our aim was to evaluate whether the clinical presentation at diagnosis differed according to age.

Methods: We evaluated retrospectively a monocentric series of 462 consecutive patients with PHPT, dividing them according to a cutoff of 65 years of age.

Results: No differences were found in the mean serum PTH, calcium, or vitamin D levels. In older patients (n = 212; 45.9%), the urinary calcium levels were significantly lower (median, 205 mg/24 hour; interquartile range, 220 mg/24 hour) compared with those in younger patients (median, 308 mg/24 hour; interquartile range, 233 mg/24 hour). In addition, renal involvement was significantly less frequent (25% vs 49.2%), and bone involvement significantly more frequent (58% vs 44%) in older patients compared with younger patients. The clinical presentation was significantly different between the two age groups, with a lower frequency of symptomatic forms and a greater frequency of asymptomatic forms not meeting surgical criteria in the older patients (44.4% vs 57.2% and 18.4% vs 5.6%, respectively). Osteoporosis was significantly more frequent in the older adults than in their younger counterparts. The most affected bone site was the forearm in older adults and the lumbar spine in younger ones (50.3% and 50.5%, respectively).

Conclusion: The clinical presentation of PHPT differs according to age, and this difference can affect the selection of management modalities.


The clinical and epidemiological presentation of sporadic primary hyperparathyroidism (PHPT) has changed profoundly during the past few decades, shifting to a largely asymptomatic disease.[1] Genetic and demographic factors have been recognized to influence the PHPT presentation.[2,3] However, it is also conceivable that technological advances in laboratory assessments and the introduction of osteoporosis screening have played important roles in western countries.[3,4] This transition has also been registered more recently in some developing countries, such as China[5] and Brazil.[6]

Few data are available regarding the influence of aging on the clinical presentation of PHPT, in particular its effect on disease management for patients >65 years (i.e., older adults).[7,8] We, thus, evaluated a large unselected series of sporadic PHPT, assessing the clinical features and the likelihood of meeting the surgical criteria recommended by current guidelines for older adults compared with younger adults.