Age-stratified differences in asymptomatic primary hyperparathyroidism: a single-center cohort study from 2017 to 2024.

BACKGROUND

Primary hyperparathyroidism (PHPT) is increasingly diagnosed as asymptomatic due to routine biochemical screening. While parathyroidectomy (PTX) is the definitive treatment, age-specific management strategies for asymptomatic patients remain contentious, particularly in patients >50 years. Current evidence lacks detailed comparisons of disease characteristics and surgical outcomes across age-stratified asymptomatic cohorts. This study aims to bridge this information gap.

METHODS

This retrospective cohort study analyzed 199 asymptomatic PHPT patients who underwent PTX at Shanghai Sixth People's Hospital between 2017 and 2024. Data regarding demographics, biochemical parameters, imaging data, surgical details, complications and outcomes were collected and compared by age at diagnosis (≤50 or >50 years).

RESULTS

Among 199 patients who underwent PTX, 128 (64.3%) were >50 years old and 71 (35.7%) were ≤50. Patients in the younger cohort (≤50 years) exhibited significantly lower preoperative 25-hydroxyvitamin D levels (P<0.001), larger parathyroid adenomas (P=0.049), stronger correlations between adenoma volume and preoperative serum parathyroid hormone (PTH) and calcium levels (P<0.001), longer operative durations (P=0.01), and higher rates of endoscopic parathyroidectomy (EPTX) (P<0.001). Quadrant-level localization accuracy via ultrasonography was significantly higher in younger patients (85.5% vs. 71.9%; P=0.03; V=0.15). Transient hypocalcemia occurred more frequently in patients ≤50 years (18.3% vs. 13.3%), although this difference was not statistically significant (P=0.34). No significant intergroup differences were observed in other postoperative complications or cure rates.

CONCLUSIONS

Patients ≤50 years demonstrated superior preoperative localization accuracy, which was associated with larger tumor size. Patients >50 years exhibited a non-significantly lower trend in transient hypocalcemia. Both age cohorts achieved comparably high surgical cure rates, supporting the efficacy of PTX across age groups for asymptomatic PHPT.