Elsevier

Endocrine Practice

Volume 18, Issue 4, July–August 2012, Pages 450-455
Endocrine Practice

Original Article
Greater Than Age-Predicted Functional Deficits In Older Patients with Primary Hyperparathyroidism

https://doi.org/10.4158/EP11206.ORGet rights and content

ABSTRACT

Objective

To compare the functional capacity of “asymptomatic” patients with primary hyperparathyroidism (PHPT) with normative values of healthy age-matched subjects.

Methods

Eighteen asymptomatic patients with PHPT met the study inclusion criteria: age > 55 years, serum calcium concentration elevated ≤ 1 mg/dL above normal, inappropriate elevation of parathyroid hormone (PTH) level, and no objective symptoms of PHPT. Functional capacity was assessed by (1) a 6-minute walk test, (2) time to complete 2 sit-to-stand maneuvers, (3) gait velocity, and (4) forward reach. Serum calcium, 25-hydroxyvitamin D, and PTH levels were measured by standard laboratory assays. Functional outcomes of the study patients were compared with age-matched normative values (unpaired t test) and correlated with these biomarkers. Because these patients often have weakness, fatigue, and malaise, we hypothesized that their functional capacity would be compromised relative to that of healthy, age-matched persons.

Results

The mean age of the patients was 65.6 years, and the mean serum calcium, PTH, and 25-hydroxyvitamin D levels (and standard deviations) were 10.36 ± 0.37 mg/dL, 122.22 ± 39.54 pg/mL, and 44.4 ± 14.27 ng/mL, respectively. Relative to normative values of healthy, agematched subjects, these patients had comparable 6-minute walk distances but required a 37% longer time to complete a repeated sit-to-stand maneuver (P < .05), demonstrated a 52% slower gait speed (P < .001), and had a greater forward reach (P = .05).

Conclusion

Our findings suggest that older asymptomatic patients with PHPT may have significant functional deficits that can affect their safety and quality of life. Therefore, their functional capacity should be routinely evaluated, and identified deficits should be treated with appropriate interventions. (Endocr Pract. 2012;18: 450-455)

Section snippets

INTRODUCTION

Primary hyperparathyroidism (PHPT) is a complex endocrine disease characterized somatically by nephrolithiasis, myopathy, and osteitis fibrosa cystica and biochemically by high serum calcium and inappropriately elevated parathyroid hormone (PTH) levels (1). Women have this disease more frequently than do men and, importantly, the incidence of PHPT increases as a function of age (1). With routine serum analysis having become more commonplace than in the past, a unique cohort of patients have

Patient Selection

Patients who presented with biochemically confirmed PHPT but did not meet objective criteria for parathyroidectomy suggested by consensus conference guidelines (that is, were asymptomatic) were asked to participate in this study. The additional inclusion criteria were as follows: age > 55 years, serum calcium concentration elevated ≤ 1 mg/dL above normal, and inappropriately increased PTH level. After patients signed informed consent documents, their serum intact PTH and calcium levels were

RESULTS

Demographic information regarding our study cohort of 18 asymptomatic patients with PHPT is presented in Table 1. As anticipated, older women constituted the majority of this study population, and participants were, on average, older and slightly obese, as defined by their body mass index (19). The results of the blood chemistry studies were elevated, as shown in Table 2. (See Table 2.)

On average, patients in this study walked 517.8 meters (1,699 feet) during the 6-minute walk test (Table 3).

DISCUSSION

More than 80% of contemporary patients with PHPT are considered asymptomatic at the time of diagnosis, presenting with a variety of subjective symptoms including depression, easy fatigability, proximal muscle weakness, lethargy, and malaise (1, 2, 3). Results from the current study extend these symptoms to include physical and functional deficits, particularly in functional activities predicated primarily on strength—that is, gait speed and repeated sitto-stand maneuvers (Table 3).

CONCLUSION

In summary, these findings suggest that asymptomatic patients with PHPT may present with significant functional deficits that, because of their age, may increase their risk for further morbidity, disability, and mortality. Accordingly, identification of these patients and encouraging physical rehabilitation may be an important adjuvant intervention. Lastly, if these functional deficits can be causally associated with PTH status, then functional capacity may have a role in determining the

DISCLOSURE

The authors have no multiplicity of interest to disclose.

ACKNOWLEDGMENT

Dr. Perrier was supported by a Jahnigen Career Development Award from the American Geriatrics Society.

We express our sincere appreciation to the patients who gave of their time and effort to make this study possible. Nothing is accomplished in the medical setting without the assistance of caregivers, and we extend our deep appreciation to this group. We thank Nancy Thompson and Linda McGraw for providing excellent administrative and clinical support for this study.

These data were presented in

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