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• W4323531192 abstract "Primary hyperparathyroidism (PHPT), a disorder in which the parathyroid glands produce excessive amounts of parathyroid hormone, is most common in older adults and postmenopausal women. While most people with PHPT are asymptomatic at diagnosis, symptomatic disease can lead to hypercalcaemia, osteoporosis, renal stones, cardiovascular abnormalities and reduced quality of life. Surgical removal of abnormal parathyroid tissue (parathyroidectomy) is the only established treatment for adults with symptomatic PHPT to prevent exacerbation of symptoms and to be cured of PHPT. However, the benefits and risks of parathyroidectomy compared to simple observation or medical therapy for asymptomatic and mild PHPT are not well established.To evaluate the benefits and harms of parathyroidectomy in adults with PHPT compared to simple observation or medical therapy.We searched CENTRAL, MEDLINE, LILACS, ClinicalTrials.gov and WHO ICTRP from their date of inception until 26 November 2021. We applied no language restrictions.We included randomised controlled trials (RCTs) comparing parathyroidectomy with simple observation or medical therapy for the treatment of adults with PHPT.We used standard Cochrane methods. Our primary outcomes were 1. cure of PHPT, 2. morbidity related to PHPT and 3. serious adverse events. Our secondary outcomes were 1. all-cause mortality, 2. health-related quality of life and 3. hospitalisation for hypercalcaemia, acute renal impairment or pancreatitis. We used GRADE to assess the certainty of the evidence for each outcome.We identified eight eligible RCTs that included 447 adults with (mostly asymptomatic) PHPT; 223 participants were randomised to parathyroidectomy. Follow-up duration varied from six months to 24 months. Of the 223 participants (37 men) randomised to surgery, 164 were included in the analyses, of whom 163 were cured at six to 24 months (overall cure rate 99%). Parathyroidectomy compared to observation probably results in a large increase in cure rate at six to 24 months follow-up: 163/164 participants (99.4%) in the parathyroidectomy group and 0/169 participants in the observation or medical therapy group were cured of their PHPT (8 studies, 333 participants; moderate certainty). No studies explicitly reported intervention effects on morbidities related to PHPT, such as osteoporosis, osteopenia, kidney dysfunction, urolithiasis, cognitive dysfunction or cardiovascular disease, although some studies reported surrogate outcomes for osteoporosis and cardiovascular disease. A post-hoc analysis revealed that parathyroidectomy, compared to observation or medical therapy, may have little or no effect after one to two years on bone mineral density (BMD) at the lumbar spine (mean difference (MD) 0.03 g/cm2,95% CI -0.05 to 0.12; 5 studies, 287 participants; very low certainty). Similarly, compared to observation, parathyroidectomy may have little or no effect on femoral neck BMD after one to two years (MD -0.01 g/cm2, 95% CI -0.13 to 0.11; 3 studies, 216 participants; very low certainty). However, the evidence is very uncertain for both BMD outcomes. Furthermore, the evidence is very uncertain about the effect of parathyroidectomy on improving left ventricular ejection fraction (MD -2.38%, 95% CI -4.77 to 0.01; 3 studies, 121 participants; very low certainty). Four studies reported serious adverse events. Three of these reported zero events in both the intervention and control groups; consequently, we were unable to include data from these three studies in the pooled analysis. The evidence suggests that parathyroidectomy compared to observation may have little or no effect on serious adverse events (RR 3.35, 95% CI 0.14 to 78.60; 4 studies, 168 participants; low certainty). Only two studies reported all-cause mortality. One study could not be included in the pooled analysis as zero events were observed in both the intervention and control groups. Parathyroidectomy compared to observation may have little or no effect on all-cause mortality, but the evidence is very uncertain (RR 2.11, 95% CI 0.20 to 22.60; 2 studies, 133 participants; very low certainty). Three studies measured health-related quality of life using the 36-Item Short Form Health Survey (SF-36) and reported inconsistent differences in scores for different domains of the questionnaire between parathyroidectomy and observation. Six studies reported hospitalisations for the correction of hypercalcaemia. Two studies reported zero events in both the intervention and control groups and could not be included in the pooled analysis. Parathyroidectomy, compared to observation, may have little or no effect on hospitalisation for hypercalcaemia (RR 0.91, 95% CI 0.20 to 4.25; 6 studies, 287 participants; low certainty). There were no reported hospitalisations for renal impairment or pancreatitis.In accordance with the literature, our review findings suggest that parathyroidectomy, compared to simple observation or medical (etidronate) therapy, probably results in a large increase in cure rates of PHPT (with normalisation of serum calcium and parathyroid hormone levels to laboratory reference values). Parathyroidectomy, compared with observation, may have little or no effect on serious adverse events or hospitalisation for hypercalcaemia, and the evidence is very uncertain about the effect of parathyroidectomy on other short-term outcomes, such as BMD, all-cause mortality and quality of life. The high uncertainty of evidence limits the applicability of our findings to clinical practice; indeed, this systematic review provides no new insights with regard to treatment decisions for people with (asymptomatic) PHPT. In addition, the methodological limitations of the included studies, and the characteristics of the study populations (mainly comprising white women with asymptomatic PHPT), warrant caution when extrapolating the results to other populations with PHPT. Large-scale multi-national, multi-ethnic and long-term RCTs are needed to explore the potential short- and long-term benefits of parathyroidectomy compared to non-surgical treatment options with regard to osteoporosis or osteopenia, urolithiasis, hospitalisation for acute kidney injury, cardiovascular disease and quality of life." @default.
• W4323531192 created "2023-03-09" @default.
• W4323531192 creator A5034415822 @default.
• W4323531192 creator A5037611493 @default.
• W4323531192 creator A5053623914 @default.
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• W4323531192 creator A5082648162 @default.
• W4323531192 creator A5086652497 @default.
• W4323531192 date "2023-03-08" @default.
• W4323531192 modified "2023-10-17" @default.
• W4323531192 title "Parathyroidectomy for adults with primary hyperparathyroidism" @default.
• W4323531192 cites W1537972189 @default.
• W4323531192 cites W1592653824 @default.
• W4323531192 cites W1600041372 @default.
• W4323531192 cites W1853587219 @default.
• W4323531192 cites W1916364140 @default.
• W4323531192 cites W1952656752 @default.
• W4323531192 cites W1966190013 @default.
• W4323531192 cites W1972948056 @default.
• W4323531192 cites W1988275305 @default.
• W4323531192 cites W1993829351 @default.
• W4323531192 cites W2004335244 @default.
• W4323531192 cites W2004513928 @default.
• W4323531192 cites W2005111245 @default.
• W4323531192 cites W2029806770 @default.
• W4323531192 cites W2035295349 @default.
• W4323531192 cites W2036414489 @default.
• W4323531192 cites W2037770102 @default.
• W4323531192 cites W2038434273 @default.
• W4323531192 cites W2041515953 @default.
• W4323531192 cites W2041831912 @default.
• W4323531192 cites W2046391772 @default.
• W4323531192 cites W2047568112 @default.
• W4323531192 cites W2061266061 @default.
• W4323531192 cites W2074821787 @default.
• W4323531192 cites W2081569600 @default.
• W4323531192 cites W2083477108 @default.
• W4323531192 cites W2087011012 @default.
• W4323531192 cites W2100650429 @default.
• W4323531192 cites W2106561198 @default.
• W4323531192 cites W2111831785 @default.
• W4323531192 cites W2114710197 @default.
• W4323531192 cites W2119605658 @default.
• W4323531192 cites W2132169735 @default.
• W4323531192 cites W2134638476 @default.
• W4323531192 cites W2141181274 @default.
• W4323531192 cites W2145555293 @default.
• W4323531192 cites W2146091120 @default.
• W4323531192 cites W2150182249 @default.
• W4323531192 cites W2154722395 @default.
• W4323531192 cites W2160658686 @default.
• W4323531192 cites W2160795579 @default.
• W4323531192 cites W2162944563 @default.
• W4323531192 cites W2188367241 @default.
• W4323531192 cites W2228346039 @default.
• W4323531192 cites W2254929923 @default.
• W4323531192 cites W2281537058 @default.
• W4323531192 cites W2286885756 @default.
• W4323531192 cites W2328043167 @default.
• W4323531192 cites W2336922360 @default.
• W4323531192 cites W2340013772 @default.
• W4323531192 cites W2409658868 @default.
• W4323531192 cites W2499214176 @default.
• W4323531192 cites W2515002635 @default.
• W4323531192 cites W2515544542 @default.
• W4323531192 cites W2515555555 @default.
• W4323531192 cites W2612683502 @default.
• W4323531192 cites W2615878544 @default.
• W4323531192 cites W2618386635 @default.
• W4323531192 cites W2737356508 @default.
• W4323531192 cites W2753358648 @default.
• W4323531192 cites W2766183272 @default.
• W4323531192 cites W2766632783 @default.
• W4323531192 cites W2786687781 @default.
• W4323531192 cites W2803127555 @default.
• W4323531192 cites W2805809614 @default.
• W4323531192 cites W2883509757 @default.
• W4323531192 cites W2921120758 @default.
• W4323531192 cites W2932818630 @default.
• W4323531192 cites W2936806137 @default.
• W4323531192 cites W2947367046 @default.
• W4323531192 cites W2969965125 @default.
• W4323531192 cites W2979650061 @default.
• W4323531192 cites W2979988094 @default.
• W4323531192 cites W2983079501 @default.
• W4323531192 cites W3093419226 @default.
• W4323531192 cites W3096033576 @default.
• W4323531192 cites W3118615836 @default.
• W4323531192 cites W3216724161 @default.
• W4323531192 cites W4211249087 @default.
• W4323531192 cites W4214585620 @default.
• W4323531192 cites W4220765658 @default.
• W4323531192 cites W4224235140 @default.
• W4323531192 cites W4243803539 @default.
• W4323531192 cites W4281766696 @default.
• W4323531192 cites W4293421387 @default.
• W4323531192 cites W4323531192 @default.
• W4323531192 doi "https://doi.org/10.1002/14651858.cd013035.pub2" @default.
• W4323531192 hasPubMedId "https://pubmed.ncbi.nlm.nih.gov/36883976" @default.

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