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Primary Hyperparathyroidism: A Review of the Long-term Surgical and Nonsurgical Morbidities as a Basis for a Rational Approach to Treatment

Primary Hyperparathyroidism: A Review of the Long-term Surgical and Nonsurgical Morbidities as a... Abstract • We studied long-term morbidity after parathyroid surgery for primary hyperparathyroidism in 100 patients and compared it with the long-term morbidity of medical follow-up from the literature. The surgical treatment of primary hyperparathyroidism was associated with negative results of neck explorations, persistent hypercalcemia, recurrent hypercalcemia, permanent hypoparathyroidism, or recurrent laryngeal nerve damage in 13 (19%) of 68 patients followed up for five years postoperatively. A review of medical follow-up as reported in the literature showed progression of disease in 8% to 22% of patients followed up for five to ten years. There was no convincing evidence that mild primary hyperparathyroidism resulted in progressive osteoporosis or renal failure. Furthermore, no significant improvement in hypertension, peptic ulcer disease, or renal function followed successful parathyroid surgery. Unless future studies demonstrate progressive osteoporosis or renal damage in untreated, mild primary hyperparathyroidism, medical follow-up is a reasonable alternative to surgery in the compliant patient over 50 years of age. (Arch Intern Med 1989;149:789-796) References 1. Heath DA, Wright AD, Barnes AD, et al: Surgical treatment of primary hyperparathyroidism in the elderly . Br Med J 1980;280:1406-1408.Crossref 2. Coe FL, Favus MJ: Does mild, asymptomatic hyperparathyroidism require surgery? N Engl J Med 1980;302:224-225.Crossref 3. Russell CF, Edis AJ: Surgery for primary hyperparathyroidism: Experience with 500 consecutive cases and evaluation of the role of surgery in the asymptomatic patient . Br J Surg 1982;69:244-247.Crossref 4. Barzel US: Indications for surgery in the management of mild hyperparathyroidism in the elderly . Geriatr Med Today 1983;2:27-35. 5. Avioli LV: Primary hyperparathyroidism: Recognition and management . Hosp Pract 1987;22:69-74. 6. Van't Hoff W, Ballardie FW, Bicknell EJ: Primary hyperparathyroidism: The case for medical management . Br Med J 1983;287:1605-1608.Crossref 7. Pearson MW: Asymptomatic primary hyperparathyroidism in the elderly: A review . Age Ageing 1984;13:1-5.Crossref 8. Gaz RD, Wang C: Management of asymptomatic hyperparathyroidism . Am J Surg 1984;147:498-502.Crossref 9. Posen S, Clifton-Bligh P, Reeve TS, et al: Is parathyroidectomy of benefit in primary hyperparathyroidism? Q J Med 1985;54:241-251. 10. Sivula A, Ronni-Sivula H: Observations on 334 patients operated on for primary hyperparathyroidism . Ann Chir Gynaecol 1985;74:66-73. 11. Rudberg C, Akerström G, Palmér M, et al: Late results of operation for primary hyperparathyroidism in 441 patients . Surgery 1986;99:643-651. 12. Palmér M, Adami HO, Bergström R, et al: Mortality after surgery for primary hyperparathyroidism: A followup of 441 patients operated on from 1956 to 1979 . Surgery 1987;102:1-7. 13. Palmér M, Ljunghall S, Akerström G, et al: Patients with primary hyperparathyroidism operated on over a 24 year period: Temporal trends of clinical and laboratory findings . J Chronic Dis 1987;40:121-130.Crossref 14. Ronni-Sivula H, Sivula A: Long-term effect of surgical treatment on the symptoms of primary hyperparathyroidism . Ann Clin Res 1985;17: 144-147. 15. Scholz DA, Purnell DC: Asymptomatic primary hyperparathyroidism: Ten year prospective study . Mayo Clin Proc 1981;56:473-478. 16. Lafferty FW: Primary hyperparathyroidism: Changing clinical spectrum, prevalence of hypertension, and discriminant analysis of laboratory tests . Arch Intern Med 1981;141:1761-1766.Crossref 17. Cann CE, Genant HK, Ettinger B, et al: Spine mineral loss in oophorectomized women . JAMA 1980;244:2056-2059.Crossref 18. Brasier AR, Nussbaum SR: Hungry bone syndrome: Clinical and biochemical predictors of its occurrence after parathyroid surgery . Am J Med 1988;84:654-660.Crossref 19. Cann CE, Genant HK, Kolb FO, et al: Quantitative computed tomography for prediction of vertebral fracture risk . Bone 1985;6:1-7.Crossref 20. Ronni-Sivula H: Causes of death in patients previously operated on for primary hyperparathyroidism . Ann Chir Gynaecol 1985;74:13-18. 21. Davies DR: The surgery of primary hyperparathyroidism . Clin Endocrinol Metab 1974;3:253-265.Crossref 22. Myers RT: Followup study of surgically-treated primary hyperparathyroidism . Ann Surg 1974;179:729-733.Crossref 23. Clark OH, Way LW, Hunt TK: Recurrent hyperparathyroidism . Ann Surg 1976;184:391-402.Crossref 24. Cowie GA: Morbidity in adult parathyroid surgery . J R Soc Med 1982;75:942-945. 25. Paloyan E, Lawrence AM, Oslapas R, et al: Subtotal parathyroidectomy for primary hyperparathyroidism . Arch Surg 1983;118:425-431.Crossref 26. Satava RM, Beahrs OH, Scholz DA: Success rate of cervical exploration for hyperparathyroidism . Arch Surg 1975;110:625-627.Crossref 27. Brennan MF, Marx SJ, Doppman J, et al: Results of reoperation for persistent and recurrent hyperparathyroidism . Ann Surg 1981;194:671-676.Crossref 28. Blancherd BM: Focal hypocalcemic seizures 33 years after thyroidectomy . Arch Intern Med 1962;110:382-385.Crossref 29. Bull DM, Dillihunt RC: Hypoparathyroidism presenting with convulsions 28 years after thyroidectomy . JAMA 1965;193:128-129.Crossref 30. Edis AJ, Beahrs OH, van Heerden JA, et al: 'Conservative' versus 'liberal' approach to parathyroid neck exploration . Surgery 1977;82:466-473. 31. Kaplan EL, Bartlett S, Sugimoto J, et al: Relation of postoperative hypocalcemia to operative techniques: Deleterious effect of excessive use of parathyroid biopsy . Surgery 1982;92:827-834. 32. Ohlsson L: Renal function in hyperparathyroidism . Acta Endocrinol 1970;63:161-174. 33. Van't Hoff W Ballardie FW, Bicknell EJ: Primary hyperparathyroidism: The case for medical management . Br Med J 1983;287:1605-1608.Crossref 34. Jones DB, Jones JH, Lloyd HJ, et al: Changes in blood pressure and renal function after parathyroidectomy in primary hyperparathyroidism . Postgrad Med J 1983;59:350-353.Crossref 35. Pyrah LN, Hodgkinson A, Anderson CK: Primary hyperparathyroidism . Br J Surg 1966;53:245-316.Crossref 36. Steinbach HL, Gordan GS, Eisenberg E, et al: Primary hyperparathyroidism: A correlation of roentgen, clinical, and pathologic features . AJR 1961;86:329-343. 37. Karpati G, Frame B: Neuropsychiatric disorders in primary hyperparathyroidism . Arch Neurol 1964;10:387-397.Crossref 38. Petersen P: Psychiatric disorders in primary hyperparathyroidism . J Clin Endocrinol Metab 1968;28:1491-1495.Crossref 39. Joborn C, Hetta J, Rastad J, et al: Psychiatric symptoms and cerebrospinal fluid monamine metabolites in primary hyperparathyroidism . Biol Psychiatry 1988;23:149-158.Crossref 40. Bess MA, Edis AJ, van Heerden JA: Hyperparathyroidism and pancreatitis: Chance or causal association? JAMA 1980;243:246-247.Crossref 41. Reeve TS, Delbridge LW: Pancreatitis following parathyroid surgery . Ann Surg 1982;195:158-162.Crossref 42. Gough MH, Smith R, Bishop MC: Parathyroidectomy for symptomless hyperparathyroidism: A surgical dilemma . Lancet 1971;1:1178.Crossref 43. Barreras RF: Calcium and gastric secretion . Gastroenterology 1973; 64:1168-1184. 44. Ostrow JD, Blandsherd G, Gray SJ: Peptic ulcer in primary hyperparathyroidism . Am J Med 1960;29:769-779.Crossref 45. Diamond TW, Botha JR, Wing J, et al: Parathyroid hypertension: A reversible disorder . Arch Intern Med 1986;146:1709-1712.Crossref 46. Rohl PE, Wilkinson M, Clifton-Bligh P, et al: Hyperparathyroidism: Experiences with treated and untreated patients . Med J Aust 1981;1:519-521. 47. Adams PH: Conservative management of primary hyperparathyroidism . JR Coll Phys Lond 1982;16:184-190. 48. Neer R, cited by Kleerekoper M: Management of primary hyperparathyroidism: Overview , in Frame B, Potts JT Jr (eds): Clinical Disorders of Bone and Mineral Metabolism . Amsterdam, Excerpta Medica, 1983, p 150. 49. Paterson CR, Burns J, Mowat E: Long term follow up of untreated primary hyperparathyroidism . Br Med J 1984;289:1261-1263.Crossref 50. Parks J, Coe F, Favus M: Hyperparathyroidism in nephrolithiasis . Arch Intern Med 1980;140:1479-1481.Crossref 51. Kyle LH, Beisel WR, Emary JJ: Evaluation of relative value of diagnostic tests in hyperparathyroidism . Ann Intern Med 1962;57:957-962.Crossref 52. Peacock M, Horsman A, Aaron JE, et al: The role of parathyroid hormone in bone loss , in Christiansen C, Arnaud CD, Nordin BEC, et al (eds): Osteoporosis . Copenhagen, Aalborg Stiftsbogtrykkeri, 1984, pp 463-467. 53. Dauphine RT, Riggs BL, Scholz DA: Back pain and vertebral crush fractures: An unemphasized mode of presentation for primary hyperparathyroidism . Ann Intern Med 1975;83:365-367.Crossref 54. Kochersberger G, Buckley NJ, Leight GS, et al: What is the clinical significance of bone loss in primary hyperparathyroidism? Arch Intern Med 1987;147:1951-1953.Crossref 55. Wilson R, Rao SD, Kleerekoper M, et al: Is asymptomatic primary hyperparathyroidism a risk factor for vertebral compression fractures? J Bone Mineral Res 1987;2( (S-1) ):109. 56. Pak CYC, Kaplan R, Notz C, et al: Photon absorptiometric analysis of bone density in primary hyperparathyroidism . Lancet 1975;2:7-8.Crossref 57. Kaplan RA, Snyder WH, Stewart A, et al: Metabolic effects of parathyroidectomy in asymptomatic primary hyperparathyroidism . J Clin Endocrinol Metab 1976;42:415-426.Crossref 58. Leppla DC, Snyder W, Pak CYC: Sequential changes in bone density before and after parathyroidectomy in primary hyperparathyroidism . Invest Radiol 1982;17:604-606.Crossref 59. Seeman E, Wahner HW, Offord KP, et al: Differential effects of endocrine dysfunction on the axial and appendicular skeleton . J Clin Invest 1982;69:1302-1309.Crossref 60. Nagant de Deuxchaisnes C, Devogelaer JP, Huaux JP: Long term followup of untreated primary hyperparathyroidism . Br Med J 1985;290: 64-65.Crossref 61. Martin P, Bergmann P, Gillet C, et al: Partially reversible osteopenia after surgery for primary hyperparathyroidism . Arch Intern Med 1986; 146:689-691.Crossref 62. Mautalen C, Reyes HR, Ghiringhelli G, et al: Cortical bone mineral content in primary hyperparathyroidism: Changes after parathyroidectomy . Acta Endocrinol 1986;111:494-497. 63. Horowitz M, Wishart J, Need AG, et al: Treatment of postmenopausal hyperparathyroidism with norethindrone: Effect on biochemistry and forearm mineral density . Arch Intern Med 1987;147:681-685.Crossref 64. Cohn SH, Roginsky MS, Aloia JF, et al: Alterations in skeletal calcium and phosphorus in dysfunction of the parathyroids . J Clin Endocrinol Metab 1973;36:750-755.Crossref 65. Jimenez LE, Spinks TJ, Ranicar ASO, et al: Total body calcium mass in primary hyperparathyroidism and long-term changes . Calcif Tissue Int 1984;36:14-18.Crossref 66. Eastell R, Kennedy NSJ, Smith MA, et al: Changes in total body calcium following surgery for primary hyperparathyroidism . Bone 1986;7: 269-272.Crossref 67. Pozzi-Mucelli RS, Kanter AS, Genant HK, et al: Quantitative bone mineral analysis in primary hyperparathyroidism . J Comput Assist Tomogr 1983;7:555.Crossref 68. Gaz RD, Wang C: Management of asymptomatic hyperparathyroidism . Am J Surg 1984;147:498-502.Crossref 69. Insogna KL, Mitnick ME, Stewart AF, et al: Sensitivity of parathyroid hormone–1,25 dihydroxyvitamin D axis to variations in calcium intake in patients with primary hyperparathyroidism . N Engl J Med 1985;313: 1126-1130.Crossref 70. Marcus R, Madvig P, Crim M, et al: Conjugated estrogens in the treatment of postmenopausal women with hyperparathyroidism . Ann Intern Med 1984;100:633-640.Crossref 71. Selby PL, Peacock M: Ethinyl estradiol and norethindrone in the treatment of primary hyperparathyroidism in post-menopausal women . N Engl J Med 1986;314:1481-1486.Crossref 72. Shane E, Baquiran DC, Bilezikian JP: Effects of dichloromethylene diphosphonate on serum and urinary calcium in primary hyperparathyroidism . Ann Intern Med 1981;95:23-27.Crossref 73. Bilezikian JP: The medical management of primary hyperparathyroidism . Ann Intern Med 1982;96:198-202.Crossref 74. Reeve J, Meunier PS, Parsons JA, et al: Anabolic effect of human parathyroid hormone fragment on trabecular bone in involutional osteoporosis: A multicenter trial . Br Med J 1980;280:1340-1344.Crossref 75. Slovik DM, Rosenthal DC, Coppelt SH, et al: Restoration of spinal bone in osteoporotic men by treatment with human parathyroid hormone (1-34) and 1,25 dihydroxy vitamin D . J Bone Mineral Res 1986;1:377-382.Crossref 76. Epstein M: Aging and the kidney: Clinical implications . Am Fam Pract 1985;31:123-137. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Internal Medicine American Medical Association

Primary Hyperparathyroidism: A Review of the Long-term Surgical and Nonsurgical Morbidities as a Basis for a Rational Approach to Treatment

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American Medical Association
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Copyright © 1989 American Medical Association. All Rights Reserved.
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0003-9926
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1538-3679
DOI
10.1001/archinte.1989.00390040031006
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Abstract

Abstract • We studied long-term morbidity after parathyroid surgery for primary hyperparathyroidism in 100 patients and compared it with the long-term morbidity of medical follow-up from the literature. The surgical treatment of primary hyperparathyroidism was associated with negative results of neck explorations, persistent hypercalcemia, recurrent hypercalcemia, permanent hypoparathyroidism, or recurrent laryngeal nerve damage in 13 (19%) of 68 patients followed up for five years postoperatively. A review of medical follow-up as reported in the literature showed progression of disease in 8% to 22% of patients followed up for five to ten years. There was no convincing evidence that mild primary hyperparathyroidism resulted in progressive osteoporosis or renal failure. Furthermore, no significant improvement in hypertension, peptic ulcer disease, or renal function followed successful parathyroid surgery. Unless future studies demonstrate progressive osteoporosis or renal damage in untreated, mild primary hyperparathyroidism, medical follow-up is a reasonable alternative to surgery in the compliant patient over 50 years of age. (Arch Intern Med 1989;149:789-796) References 1. Heath DA, Wright AD, Barnes AD, et al: Surgical treatment of primary hyperparathyroidism in the elderly . Br Med J 1980;280:1406-1408.Crossref 2. Coe FL, Favus MJ: Does mild, asymptomatic hyperparathyroidism require surgery? N Engl J Med 1980;302:224-225.Crossref 3. Russell CF, Edis AJ: Surgery for primary hyperparathyroidism: Experience with 500 consecutive cases and evaluation of the role of surgery in the asymptomatic patient . Br J Surg 1982;69:244-247.Crossref 4. Barzel US: Indications for surgery in the management of mild hyperparathyroidism in the elderly . Geriatr Med Today 1983;2:27-35. 5. Avioli LV: Primary hyperparathyroidism: Recognition and management . Hosp Pract 1987;22:69-74. 6. Van't Hoff W, Ballardie FW, Bicknell EJ: Primary hyperparathyroidism: The case for medical management . Br Med J 1983;287:1605-1608.Crossref 7. Pearson MW: Asymptomatic primary hyperparathyroidism in the elderly: A review . Age Ageing 1984;13:1-5.Crossref 8. Gaz RD, Wang C: Management of asymptomatic hyperparathyroidism . Am J Surg 1984;147:498-502.Crossref 9. Posen S, Clifton-Bligh P, Reeve TS, et al: Is parathyroidectomy of benefit in primary hyperparathyroidism? Q J Med 1985;54:241-251. 10. Sivula A, Ronni-Sivula H: Observations on 334 patients operated on for primary hyperparathyroidism . Ann Chir Gynaecol 1985;74:66-73. 11. Rudberg C, Akerström G, Palmér M, et al: Late results of operation for primary hyperparathyroidism in 441 patients . Surgery 1986;99:643-651. 12. Palmér M, Adami HO, Bergström R, et al: Mortality after surgery for primary hyperparathyroidism: A followup of 441 patients operated on from 1956 to 1979 . Surgery 1987;102:1-7. 13. Palmér M, Ljunghall S, Akerström G, et al: Patients with primary hyperparathyroidism operated on over a 24 year period: Temporal trends of clinical and laboratory findings . J Chronic Dis 1987;40:121-130.Crossref 14. Ronni-Sivula H, Sivula A: Long-term effect of surgical treatment on the symptoms of primary hyperparathyroidism . Ann Clin Res 1985;17: 144-147. 15. Scholz DA, Purnell DC: Asymptomatic primary hyperparathyroidism: Ten year prospective study . Mayo Clin Proc 1981;56:473-478. 16. Lafferty FW: Primary hyperparathyroidism: Changing clinical spectrum, prevalence of hypertension, and discriminant analysis of laboratory tests . Arch Intern Med 1981;141:1761-1766.Crossref 17. Cann CE, Genant HK, Ettinger B, et al: Spine mineral loss in oophorectomized women . JAMA 1980;244:2056-2059.Crossref 18. Brasier AR, Nussbaum SR: Hungry bone syndrome: Clinical and biochemical predictors of its occurrence after parathyroid surgery . Am J Med 1988;84:654-660.Crossref 19. Cann CE, Genant HK, Kolb FO, et al: Quantitative computed tomography for prediction of vertebral fracture risk . Bone 1985;6:1-7.Crossref 20. Ronni-Sivula H: Causes of death in patients previously operated on for primary hyperparathyroidism . Ann Chir Gynaecol 1985;74:13-18. 21. Davies DR: The surgery of primary hyperparathyroidism . Clin Endocrinol Metab 1974;3:253-265.Crossref 22. Myers RT: Followup study of surgically-treated primary hyperparathyroidism . Ann Surg 1974;179:729-733.Crossref 23. Clark OH, Way LW, Hunt TK: Recurrent hyperparathyroidism . Ann Surg 1976;184:391-402.Crossref 24. Cowie GA: Morbidity in adult parathyroid surgery . J R Soc Med 1982;75:942-945. 25. Paloyan E, Lawrence AM, Oslapas R, et al: Subtotal parathyroidectomy for primary hyperparathyroidism . Arch Surg 1983;118:425-431.Crossref 26. Satava RM, Beahrs OH, Scholz DA: Success rate of cervical exploration for hyperparathyroidism . Arch Surg 1975;110:625-627.Crossref 27. Brennan MF, Marx SJ, Doppman J, et al: Results of reoperation for persistent and recurrent hyperparathyroidism . Ann Surg 1981;194:671-676.Crossref 28. Blancherd BM: Focal hypocalcemic seizures 33 years after thyroidectomy . Arch Intern Med 1962;110:382-385.Crossref 29. Bull DM, Dillihunt RC: Hypoparathyroidism presenting with convulsions 28 years after thyroidectomy . JAMA 1965;193:128-129.Crossref 30. Edis AJ, Beahrs OH, van Heerden JA, et al: 'Conservative' versus 'liberal' approach to parathyroid neck exploration . Surgery 1977;82:466-473. 31. Kaplan EL, Bartlett S, Sugimoto J, et al: Relation of postoperative hypocalcemia to operative techniques: Deleterious effect of excessive use of parathyroid biopsy . Surgery 1982;92:827-834. 32. Ohlsson L: Renal function in hyperparathyroidism . Acta Endocrinol 1970;63:161-174. 33. Van't Hoff W Ballardie FW, Bicknell EJ: Primary hyperparathyroidism: The case for medical management . Br Med J 1983;287:1605-1608.Crossref 34. Jones DB, Jones JH, Lloyd HJ, et al: Changes in blood pressure and renal function after parathyroidectomy in primary hyperparathyroidism . Postgrad Med J 1983;59:350-353.Crossref 35. Pyrah LN, Hodgkinson A, Anderson CK: Primary hyperparathyroidism . Br J Surg 1966;53:245-316.Crossref 36. Steinbach HL, Gordan GS, Eisenberg E, et al: Primary hyperparathyroidism: A correlation of roentgen, clinical, and pathologic features . AJR 1961;86:329-343. 37. Karpati G, Frame B: Neuropsychiatric disorders in primary hyperparathyroidism . Arch Neurol 1964;10:387-397.Crossref 38. Petersen P: Psychiatric disorders in primary hyperparathyroidism . J Clin Endocrinol Metab 1968;28:1491-1495.Crossref 39. Joborn C, Hetta J, Rastad J, et al: Psychiatric symptoms and cerebrospinal fluid monamine metabolites in primary hyperparathyroidism . Biol Psychiatry 1988;23:149-158.Crossref 40. Bess MA, Edis AJ, van Heerden JA: Hyperparathyroidism and pancreatitis: Chance or causal association? JAMA 1980;243:246-247.Crossref 41. Reeve TS, Delbridge LW: Pancreatitis following parathyroid surgery . Ann Surg 1982;195:158-162.Crossref 42. Gough MH, Smith R, Bishop MC: Parathyroidectomy for symptomless hyperparathyroidism: A surgical dilemma . Lancet 1971;1:1178.Crossref 43. Barreras RF: Calcium and gastric secretion . Gastroenterology 1973; 64:1168-1184. 44. Ostrow JD, Blandsherd G, Gray SJ: Peptic ulcer in primary hyperparathyroidism . Am J Med 1960;29:769-779.Crossref 45. Diamond TW, Botha JR, Wing J, et al: Parathyroid hypertension: A reversible disorder . Arch Intern Med 1986;146:1709-1712.Crossref 46. Rohl PE, Wilkinson M, Clifton-Bligh P, et al: Hyperparathyroidism: Experiences with treated and untreated patients . Med J Aust 1981;1:519-521. 47. Adams PH: Conservative management of primary hyperparathyroidism . JR Coll Phys Lond 1982;16:184-190. 48. Neer R, cited by Kleerekoper M: Management of primary hyperparathyroidism: Overview , in Frame B, Potts JT Jr (eds): Clinical Disorders of Bone and Mineral Metabolism . Amsterdam, Excerpta Medica, 1983, p 150. 49. Paterson CR, Burns J, Mowat E: Long term follow up of untreated primary hyperparathyroidism . Br Med J 1984;289:1261-1263.Crossref 50. Parks J, Coe F, Favus M: Hyperparathyroidism in nephrolithiasis . Arch Intern Med 1980;140:1479-1481.Crossref 51. Kyle LH, Beisel WR, Emary JJ: Evaluation of relative value of diagnostic tests in hyperparathyroidism . Ann Intern Med 1962;57:957-962.Crossref 52. Peacock M, Horsman A, Aaron JE, et al: The role of parathyroid hormone in bone loss , in Christiansen C, Arnaud CD, Nordin BEC, et al (eds): Osteoporosis . Copenhagen, Aalborg Stiftsbogtrykkeri, 1984, pp 463-467. 53. Dauphine RT, Riggs BL, Scholz DA: Back pain and vertebral crush fractures: An unemphasized mode of presentation for primary hyperparathyroidism . Ann Intern Med 1975;83:365-367.Crossref 54. Kochersberger G, Buckley NJ, Leight GS, et al: What is the clinical significance of bone loss in primary hyperparathyroidism? Arch Intern Med 1987;147:1951-1953.Crossref 55. Wilson R, Rao SD, Kleerekoper M, et al: Is asymptomatic primary hyperparathyroidism a risk factor for vertebral compression fractures? J Bone Mineral Res 1987;2( (S-1) ):109. 56. Pak CYC, Kaplan R, Notz C, et al: Photon absorptiometric analysis of bone density in primary hyperparathyroidism . Lancet 1975;2:7-8.Crossref 57. Kaplan RA, Snyder WH, Stewart A, et al: Metabolic effects of parathyroidectomy in asymptomatic primary hyperparathyroidism . J Clin Endocrinol Metab 1976;42:415-426.Crossref 58. Leppla DC, Snyder W, Pak CYC: Sequential changes in bone density before and after parathyroidectomy in primary hyperparathyroidism . Invest Radiol 1982;17:604-606.Crossref 59. Seeman E, Wahner HW, Offord KP, et al: Differential effects of endocrine dysfunction on the axial and appendicular skeleton . J Clin Invest 1982;69:1302-1309.Crossref 60. Nagant de Deuxchaisnes C, Devogelaer JP, Huaux JP: Long term followup of untreated primary hyperparathyroidism . Br Med J 1985;290: 64-65.Crossref 61. Martin P, Bergmann P, Gillet C, et al: Partially reversible osteopenia after surgery for primary hyperparathyroidism . Arch Intern Med 1986; 146:689-691.Crossref 62. Mautalen C, Reyes HR, Ghiringhelli G, et al: Cortical bone mineral content in primary hyperparathyroidism: Changes after parathyroidectomy . Acta Endocrinol 1986;111:494-497. 63. Horowitz M, Wishart J, Need AG, et al: Treatment of postmenopausal hyperparathyroidism with norethindrone: Effect on biochemistry and forearm mineral density . Arch Intern Med 1987;147:681-685.Crossref 64. Cohn SH, Roginsky MS, Aloia JF, et al: Alterations in skeletal calcium and phosphorus in dysfunction of the parathyroids . J Clin Endocrinol Metab 1973;36:750-755.Crossref 65. Jimenez LE, Spinks TJ, Ranicar ASO, et al: Total body calcium mass in primary hyperparathyroidism and long-term changes . Calcif Tissue Int 1984;36:14-18.Crossref 66. Eastell R, Kennedy NSJ, Smith MA, et al: Changes in total body calcium following surgery for primary hyperparathyroidism . Bone 1986;7: 269-272.Crossref 67. Pozzi-Mucelli RS, Kanter AS, Genant HK, et al: Quantitative bone mineral analysis in primary hyperparathyroidism . J Comput Assist Tomogr 1983;7:555.Crossref 68. Gaz RD, Wang C: Management of asymptomatic hyperparathyroidism . Am J Surg 1984;147:498-502.Crossref 69. Insogna KL, Mitnick ME, Stewart AF, et al: Sensitivity of parathyroid hormone–1,25 dihydroxyvitamin D axis to variations in calcium intake in patients with primary hyperparathyroidism . N Engl J Med 1985;313: 1126-1130.Crossref 70. Marcus R, Madvig P, Crim M, et al: Conjugated estrogens in the treatment of postmenopausal women with hyperparathyroidism . Ann Intern Med 1984;100:633-640.Crossref 71. Selby PL, Peacock M: Ethinyl estradiol and norethindrone in the treatment of primary hyperparathyroidism in post-menopausal women . N Engl J Med 1986;314:1481-1486.Crossref 72. Shane E, Baquiran DC, Bilezikian JP: Effects of dichloromethylene diphosphonate on serum and urinary calcium in primary hyperparathyroidism . Ann Intern Med 1981;95:23-27.Crossref 73. Bilezikian JP: The medical management of primary hyperparathyroidism . Ann Intern Med 1982;96:198-202.Crossref 74. Reeve J, Meunier PS, Parsons JA, et al: Anabolic effect of human parathyroid hormone fragment on trabecular bone in involutional osteoporosis: A multicenter trial . Br Med J 1980;280:1340-1344.Crossref 75. Slovik DM, Rosenthal DC, Coppelt SH, et al: Restoration of spinal bone in osteoporotic men by treatment with human parathyroid hormone (1-34) and 1,25 dihydroxy vitamin D . J Bone Mineral Res 1986;1:377-382.Crossref 76. Epstein M: Aging and the kidney: Clinical implications . Am Fam Pract 1985;31:123-137.

Journal

Archives of Internal MedicineAmerican Medical Association

Published: Apr 1, 1989

References