COMPARATIVE ANALYSIS OF SURGICAL VERSUS MEDICAL TREATMENT IN NON-LOCALIZED PRIMARY HYPERPARATHYROIDISM: RENAL AND SKELETAL OUTCOMES.

AUTHORS:
S. Radellini (Palermo, Italy) , A. Scerrino (Palermo, Italy) , P. Richiusa (Palermo, Italy) , G. Scerrino (Palermo, Italy) , S. Mazzola (Palermo, Italy) , C. Giordano (Palermo, Italy) , D. Taieb (Marseille, France) , N.C. Paladino (Marseille, France) , F. Sebag (Marseille, France)
Background:
Primary hyperparathyroidism (PHPT) presents diverse phenotypic variations. Few available studies have investigated potential peculiarities of non-localized PHPT. This retrospective study aimed to compare renal and skeletal outcomes in patients with non-localized PHPT subjected to medical versus surgical treatments.
Methods:
Patients diagnosed with non-localized PHPT from two European Tertiary Centers were divided into Group A (medical treatment, 42 patients) and Group B (Surgery, 45 patients). Biochemical markers, renal function, and bone mineral density (BMD) were assessed at baseline and 18-24 months post-treatment. Initial univariate analysis confirmed age normality and homoscedasticity. Student's t-test, Fisher's exact test, Wilcoxon test, and Friedman's non-parametric test were utilized.
Results:
The two groups displayed significant differences in age and vitamin D levels. Group B exhibited notable post-operative reductions in serum calcium (p-value <0.00001, versus p<0.001 for group A), PTH (p<0.00001 versus 0.078 for group A), and calciuria (p<0.05 versus 0.3657 for group A). Surgical intervention yielded significant improvements in BMD (group B: p<0.0001; group A: p=0.3359) at femoral and lumbar sites, with no post-treatment fractures in Group B, contrasting with Group A (4 new fractures). The GFR of group A showed a statistically non-significant change with a p-value of 0.631. Conversely, for the group B, the GFR displayed a statistically significant change (p<0.001).
Conclusions:
Surgical intervention in non-localized PHPT showcased distinct advantages in normalizing calcemia and PTH levels and improving skeletal metabolism. Although few significant differences in renal function were observed post-surgery, the surgical cohort displayed better-preserved renal function compared to the group A.