Parathyroidectomy improves functional capacity in 'asymptomatic' older patients with primary hyperparathyroidism: a randomized control trial.

摘要

OBJECTIVE: We tested the hypothesis that parathyroidectomy would improve functional/physical capacity, an underlying determinant of the ability to perform activities of daily living (ADL), in older patients with asymptomatic primary hyperparathyroidism (PHPT). SUMMARY OF BACKGROUND DATA: PHPT patients often present with nonspecific, subjective symptoms including proximal muscle weakness, fatigue, and reduced physical functional. Although qualitative data suggest that parathyroidectomy reduces these symptoms in asymptomatic PHPT patients, there are no quantitative data confirming this potential surgical benefit. METHODS: Eighteen asymptomatic older (>50 years) patients with biochemically confirmed PHPT who did not meet National Institutes of Health consensus conference criteria for undergoing a parathyroidectomy were randomly assigned to either a surgical group (parathyroidectomy) or a control group (observed for 6 months). All patients underwent functional testing (6-minute walk test, 50-foot walk test, and repeated sit-to-stand test) at baseline/presurgery and at 6 weeks and 6 months after surgery or baseline. This study is registered at clinicaltrials.gov (Registration# 2007-0220 ID#NCT00501215). RESULTS: The surgery and control groups were functionally similar at baseline. Six-minute walk distance increased in the surgery group by 184 ft, a distance that is both significant (P<0.05) and clinically meaningful. Fifty foot walk and repeated sit-to-stand times in this group remain unchanged from presurgical levels. All functional measures for the control group remained unchanged over time. As anticipated, parathyroidectomy reduced serum calcium and intact parathyroid hormone levels. CONCLUSIONS: The improvement in 6-minute walk distance observed in the surgery group suggests that parathyroidectomy can improve functional capacity, and hence the performance of ADLs in asymptomatic, older PHPT patients.