Survival after the diagnosis of hyperparathyroidism: A population-based study

Robert A. Wermers, Sundeep Khosla, Elizabeth J. Atkinson, Clive S. Grant, Stephen F. Hodgson, W. Michael O'Fallon, L. Joseph Melton

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Abstract

BACKGROUND: Reports of increased mortality from cardiovascular disease and malignancy in primary hyperparathyroidism have been based primarily on patients who have undergone parathyroidectomy. In order to assess the true impact of primary hyperthyroidism on mortality in the general population, we assessed survival in a large inception cohort of Rochester, Minnesota residents with primary hyperparathyroidism initially diagnosed over a 28- year span, the majority of whom were followed with uncomplicated disease. METHODS: All Rochester residents with primary hyperparathyroidism first recognized in 1965 to 1992 were identified through the Rochester Epidemiology Project medical records linkage system. Included as cases were patients with pathologic confirmation of hyperthyroidism, hypercalcemia with inappropriately elevated parathyroid hormone levels, or hypercalcemia for more than a year with no other cause. Survival was estimated using the Kaplan Meier product-limit method. The Cox proportional hazards model was used to determine associations, as relative hazards (RR) with 95% confidence intervals (CI), of various risk factors with time to death. RESULTS: During the study period, 435 cases of primary hyperparathyroidism were identified. Altogether, parathyroid surgery was performed on 126 patients (29%), with a mean delay between the initial elevated serum calcium level and surgery of 3.3 years. Patients who underwent surgery had higher maximum serum calcium levels than the patients who were observed (mean ± SD, 11.3 ± 0.7 versus 10.7 ± 0.4 mg/dL, P <0.001), but their mean ages were similar (54 ± 16 versus 56 ± 17 years). Overall survival in the patients with primary hyperthyroidism was better than expected (P = 0.02), but by age-adjusted multivariate analysis, higher maximal serum calcium level was an independent predictor of mortality (RR = 1.3 per mg/dL; 95% CI: 1.1-1.6; P <0.02). CONCLUSION: Overall survival is not adversely affected among unselected patients with mild primary HPT in the community, although patients with more severe disease, as manifested by higher serum calcium levels, may have an increased risk of death.

Original languageEnglish (US)
Pages (from-to)115-122
Number of pages8
JournalAmerican Journal of Medicine
Volume104
Issue number2
DOIs
StatePublished - Feb 1998

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Hyperparathyroidism
Survival
Primary Hyperparathyroidism
Population
Hyperthyroidism
Calcium
Hypercalcemia
Serum
Mortality
Medical Record Linkage
Confidence Intervals
Parathyroidectomy
Kaplan-Meier Estimate
Parathyroid Hormone
Proportional Hazards Models
Epidemiology
Cardiovascular Diseases
Multivariate Analysis

ASJC Scopus subject areas

  • Nursing(all)

Cite this

Wermers, R. A., Khosla, S., Atkinson, E. J., Grant, C. S., Hodgson, S. F., O'Fallon, W. M., & Melton, L. J. (1998). Survival after the diagnosis of hyperparathyroidism: A population-based study. American Journal of Medicine, 104(2), 115-122. https://doi.org/10.1016/S0002-9343(97)00270-2

Survival after the diagnosis of hyperparathyroidism : A population-based study. / Wermers, Robert A.; Khosla, Sundeep; Atkinson, Elizabeth J.; Grant, Clive S.; Hodgson, Stephen F.; O'Fallon, W. Michael; Melton, L. Joseph.

In: American Journal of Medicine, Vol. 104, No. 2, 02.1998, p. 115-122.

Research output: Contribution to journalArticle

Wermers, RA, Khosla, S, Atkinson, EJ, Grant, CS, Hodgson, SF, O'Fallon, WM & Melton, LJ 1998, 'Survival after the diagnosis of hyperparathyroidism: A population-based study', American Journal of Medicine, vol. 104, no. 2, pp. 115-122. https://doi.org/10.1016/S0002-9343(97)00270-2
Wermers, Robert A. ; Khosla, Sundeep ; Atkinson, Elizabeth J. ; Grant, Clive S. ; Hodgson, Stephen F. ; O'Fallon, W. Michael ; Melton, L. Joseph. / Survival after the diagnosis of hyperparathyroidism : A population-based study. In: American Journal of Medicine. 1998 ; Vol. 104, No. 2. pp. 115-122.
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abstract = "BACKGROUND: Reports of increased mortality from cardiovascular disease and malignancy in primary hyperparathyroidism have been based primarily on patients who have undergone parathyroidectomy. In order to assess the true impact of primary hyperthyroidism on mortality in the general population, we assessed survival in a large inception cohort of Rochester, Minnesota residents with primary hyperparathyroidism initially diagnosed over a 28- year span, the majority of whom were followed with uncomplicated disease. METHODS: All Rochester residents with primary hyperparathyroidism first recognized in 1965 to 1992 were identified through the Rochester Epidemiology Project medical records linkage system. Included as cases were patients with pathologic confirmation of hyperthyroidism, hypercalcemia with inappropriately elevated parathyroid hormone levels, or hypercalcemia for more than a year with no other cause. Survival was estimated using the Kaplan Meier product-limit method. The Cox proportional hazards model was used to determine associations, as relative hazards (RR) with 95{\%} confidence intervals (CI), of various risk factors with time to death. RESULTS: During the study period, 435 cases of primary hyperparathyroidism were identified. Altogether, parathyroid surgery was performed on 126 patients (29{\%}), with a mean delay between the initial elevated serum calcium level and surgery of 3.3 years. Patients who underwent surgery had higher maximum serum calcium levels than the patients who were observed (mean ± SD, 11.3 ± 0.7 versus 10.7 ± 0.4 mg/dL, P <0.001), but their mean ages were similar (54 ± 16 versus 56 ± 17 years). Overall survival in the patients with primary hyperthyroidism was better than expected (P = 0.02), but by age-adjusted multivariate analysis, higher maximal serum calcium level was an independent predictor of mortality (RR = 1.3 per mg/dL; 95{\%} CI: 1.1-1.6; P <0.02). CONCLUSION: Overall survival is not adversely affected among unselected patients with mild primary HPT in the community, although patients with more severe disease, as manifested by higher serum calcium levels, may have an increased risk of death.",
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N2 - BACKGROUND: Reports of increased mortality from cardiovascular disease and malignancy in primary hyperparathyroidism have been based primarily on patients who have undergone parathyroidectomy. In order to assess the true impact of primary hyperthyroidism on mortality in the general population, we assessed survival in a large inception cohort of Rochester, Minnesota residents with primary hyperparathyroidism initially diagnosed over a 28- year span, the majority of whom were followed with uncomplicated disease. METHODS: All Rochester residents with primary hyperparathyroidism first recognized in 1965 to 1992 were identified through the Rochester Epidemiology Project medical records linkage system. Included as cases were patients with pathologic confirmation of hyperthyroidism, hypercalcemia with inappropriately elevated parathyroid hormone levels, or hypercalcemia for more than a year with no other cause. Survival was estimated using the Kaplan Meier product-limit method. The Cox proportional hazards model was used to determine associations, as relative hazards (RR) with 95% confidence intervals (CI), of various risk factors with time to death. RESULTS: During the study period, 435 cases of primary hyperparathyroidism were identified. Altogether, parathyroid surgery was performed on 126 patients (29%), with a mean delay between the initial elevated serum calcium level and surgery of 3.3 years. Patients who underwent surgery had higher maximum serum calcium levels than the patients who were observed (mean ± SD, 11.3 ± 0.7 versus 10.7 ± 0.4 mg/dL, P <0.001), but their mean ages were similar (54 ± 16 versus 56 ± 17 years). Overall survival in the patients with primary hyperthyroidism was better than expected (P = 0.02), but by age-adjusted multivariate analysis, higher maximal serum calcium level was an independent predictor of mortality (RR = 1.3 per mg/dL; 95% CI: 1.1-1.6; P <0.02). CONCLUSION: Overall survival is not adversely affected among unselected patients with mild primary HPT in the community, although patients with more severe disease, as manifested by higher serum calcium levels, may have an increased risk of death.

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