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Maximizing Opportunities: Primary Hyperparathyroidism in the Older Adult


      • Primary hyperparathyroidism creates a multisystem and life-limiting disease burden requiring early recognition to mitigate complications.
      • Rationales for undiagnosed or undertreated primary hyperparathyroidism in older adults include lack of acknowledgment or evaluation of abnormal calcium levels.
      • Older adults with primary hyperparathyroidism may present with clusters of vague symptoms like other commonly seen conditions in older adults.
      • A single parathyroid adenoma is responsible for 80% to 85% of primary hyperparathyroidism, causing subjective cognitive impairment, osteoporosis-associated bone/joint pain, neuropsychiatric symptoms, renal damage, functionality, and poor quality of life.
      • Mortality from primary hyperparathyroidism in older adults may be attributed to causes of death related to undiagnosed primary hyperparathyroidism complications (eg, cardiovascular disease and renal disease).
      • Recognition of disease processes affected or caused by unsuppressed parathyroid hormone and its effect on serum Ca2+ and the vitamin D axis is critical to improve health promotion and disease prevention in older adults.


      Primary hyperparathyroidism creates a multisystem and life-limiting disease burden requiring early recognition to mitigate potential complications. A single parathyroid adenoma is responsible for 80% to 85% of primary hyperparathyroidism, causing subjective cognitive impairment, neuropsychiatric symptoms, osteoporosis-associated bone/joint pain, renal damage, functionality, and poor quality of life. The benefits of treatment include clinically significant fracture risk reduction, improvement in left ventricular hypertrophy, and frailty indices. The criteria for parathyroidectomy to resolve primary hyperparathyroidism are less clear for those over age 85. Evidence-based screening tools are available for advanced practice nurses to quantify the associated risk of complications and poor outcomes.


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      Candace C. Harrington, PhD, DNP, AGPCNP-BC, CNE, is an assistant professor and the gerontology nurse practitioner professor at the University of Louisville School of Nursing in Louisville, KY, and can be contacted at [email protected]


      Dedra M. Hayden, DNP, ANP-BC, is an associate professor, the director of the Kentucky Racing Health Services Center, and adult gerontology primary care nurse practitioner track coordinator at the University of Louisville School of Nursing.