SAT-768 Age-Specific Differences in Parathyroidectomy After Implementation of Management Guidelines for Primary Hyperparathyroidism

Abstract Disclosure: G.J. Acosta: None. R.E. Medina: None. M. Kabbash: None. P.T. Dziegielewski: None. C.M. Shaw: None. A.S. Shirali: None. Introduction: Older adults experience declining rates of parathyroidectomy despite meeting indications for surgery based on management guidelines for primary hyperparathyroidism. We sought to examine age-specific differences in the diagnosis of primary hyperparathyroidism (PHPT), time to surgery, and indications for surgery in patients who were offered parathyroidectomy. Methods: Adult patients with sporadic PHPT who underwent parathyroidectomy at a single tertiary academic medical center between 1/1/2017 and 12/31/2022 were identified. The 2016 American Association of Endocrine Surgeons (AAES) Guidelines and the Fourth International Workshop Guidelines for definitive management of PHPT were used to identify evidence-based indications for surgery. The number of patients with a complete preoperative evaluation, defined as pre-op corrected serum calcium, PTH, 25-hydroxy vitamin D, eGFR, DXA scan or bone imaging, and 24-hour urine calcium, was calculated. Results: Two hundred sixty-six patients (median age 63.2 years, 74.8% female) underwent parathyroidectomy for PHPT. From the total 266 patients, 145 patients (54.5%) were <65 years (median age 54.9 years) and 121 patients (45.5%) were ≥65 years (median age 71.4 years). There was no significant difference in the interval of time from initial calcium elevation to first PTH testing between the two groups. The median time from biochemical diagnosis to surgery was significantly shorter for patients <65 years (7.53 months vs 14.5 months, p<0.05). Patients ≥65 years were more likely to undergo parathyroidectomy due to bone disease (31.4 vs 20.0%, p<0.05). Patients ≥65 years who underwent parathyroidectomy were less likely to have nephrolithiasis (29.8% vs 43.3%, p<0.05) and more likely to have eGFR <60 (43.8% vs 13.1%, p<0.001). Only 86 patients (32.3%) underwent complete preoperative evaluation for PHPT prior to being offered parathyroidectomy, with no difference between those <65 years and those ≥65 years (31.7% vs 32.2%, respectively, p>0.005). Conclusions: Older adults undergo parathyroidectomy twice as long after the initial biochemical diagnosis compared to patients <65 years despite having similarly low rates of complete preoperative evaluation. Older adults were more likely to undergo surgery for bone disease and renal dysfunction. Older adult patients may benefit from more comprehensive evaluations and earlier referral to surgery to mitigate negative skeletal, renal and cardiovascular outcomes. Presentation: Saturday, July 12, 2025