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Abstract

Background

Therapeutic options in primary hyperparathyroidism (HPT) have not been analysed in postmenopausal women recruited by population-based screening.

Methods

Postmenopausal women (n = 92) with HPT detected at population-based screening entered into a prospective case–control comparison at mean(s.d.) 66·5(6·0) years of age. Biochemical signs of HPT were mild (mean(s.d.) serum calcium 2·59(0·14) mmol l−1) and cases were considered overtly asymptomatic. Parathyroid surgery, oestrogen replacement therapy (ERT; ethinyloestradiol), ERT and surgery, and conservative surveillance were evaluated after 1, 2 and 5 years. Follow-up was complete in 75 per cent of the patients.

Results

Parathyroid surgery rendered the total and ionized calcium, and intact parathyroid hormone (PTH) values in blood, and the urinary calcium excretion indistinguishable between cases and controls. ERT was maintained during approximately 80 per cent of the follow-up period. It reduced the blood calcium levels significantly and tended to increase the serum PTH level. Significant discrepancies, however, persisted towards the controls. ERT added no significant changes to the biochemical outcome of parathyroidectomy. Conservatively treated cases had essentially stable parameters over the study period.

Conclusion

Parathyroidectomy was the only treatment option that normalized basic variables of the calcium homoeostasis to control levels in postmenopausal women with mild primary HPT. © 2000 British Journal of Surgery Society Ltd