Delayed Calcium Normalization After Presumed Curative Parathyroidectomy is Not Associated with the Development of Persistent or Recurrent Primary Hyperparathyroidism

Lai, Victoria; Doffek, Kara; Carr, Azadeh A.; Carroll, Ty B.; Fareau, Gilbert G.; Evans, Douglas B.; Wang, Tracy

doi:10.1245/s10434-016-5190-7

Cited by 8 publications

(9 citation statements)

References 26 publications

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“…Most patients with PHPT have normal serum calcium levels within the first two weeks after parathyroidectomy, and 96% will have normal serum calcium levels in the first postoperative month. Hypercalcemia that does not normalize within the first 30 days postoperatively has been associated with persistent PHPT [6], which is defined as a failure to achieve normocalcemia within 6 months after parathyroidectomy [1]. e early biochemical response of PTH and serum calcium levels after parathyroidectomy is the main predictor 2…”

Section: Discussionmentioning

confidence: 99%

“…e decrease of PTH by 50% or more from levels prior to surgery after excision predicts a successful parathyroidectomy. Serum calcium is expected to return to normal within 24-72 hours after surgery; however, approximately 10% of patients have transient, persistent postoperative hypercalcemia [6]. We present a case report of delayed calcium normalization after successful parathyroidectomy in a 38year-old patient with PHPT.…”

Section: Introductionmentioning

confidence: 90%

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Delayed Calcium Normalization after Successful Parathyroidectomy in Primary Hyperparathyroidism

Rodríguez

Montesinos

Rodríguez-Delgado

et al. 2021

Case Reports in Endocrinology

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Introduction. Parathyroidectomy is the curative treatment option in primary hyperparathyroidism (PHPT). The decrease of parathormone (PTH) by 50% or more from levels prior to surgery after excision predicts successful parathyroidectomy. Serum calcium is expected to return to normal within 24–72 hours after the surgery; however, nearly 10% have transient, persistent postoperative hypercalcemia. We present a case report of delayed calcium normalization after successful parathyroidectomy in a 38-year-old patient with PHPT. Methods. Parathyroidectomy was performed, with evidence of a decrease in PTH levels of more than 50% in the first 24 hours postoperatively compared to presurgical PTH; however, despite curative parathyroidectomy, a delayed calcium normalization was evidenced, with hypercalcemia persistence up to 120 hours postoperatively. Results. After the first month postoperatively, serum calcium remained normal. In conclusion, approximately 10% of patients with curative parathyroidectomy have transient, persistent postoperative hypercalcemia, which is more likely to occur in patients with higher preoperative serum calcium and PTH levels. Conclusion. Persistent hypercalcemia after the first month postoperatively is related with persistent PHPT, highlighting the importance of calcium monitoring after parathyroidectomy to predict short-term, medium-term, and long-term outcomes and prognosis.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 90%

Delayed Calcium Normalization after Successful Parathyroidectomy in Primary Hyperparathyroidism

Rodríguez

Montesinos

Rodríguez-Delgado

et al. 2021

Case Reports in Endocrinology

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“…Based on our observations, we believe that patients should be examined every three months after PTX for the first two years, and then twice a year afterwards. Some authors indicate that this should last for even more than 10 years after parathyroidectomy [34].…”

Section: Discussionmentioning

confidence: 99%

Surgical Management of Primary Hyperparathyroidism—Clinicopathologic Study of 1019 Cases from a Single Institution

Gawrychowski

Kowalski

Buła

et al. 2020

JCM

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Background: Primary hyperparathyroidism (pHPT) is an endocrine disorder characterized by hypercalcemia and caused by the presence of disordered parathyroid glands. Parathyroidectomy is the only curative therapy for pHPT, but despite its high cure rate of 95–98%, there are still cases where hypercalcemia persists after this surgical procedure. The aim of this study was to present the results of a surgical treatment of patients due to primary hyperparathyroidism and failures related to the thoracic location of the affected glands. Methods: We present a retrospective analysis of 1019 patients who underwent parathyroidectomy in our department in the period 1983–2018. Results: Among the group of 1019 operated-on patients, treatment failed in 19 cases (1.9%). In 16 (84.2%) of them, the repeated operation was successful. In total, 1016 patients returned to normocalcemia. Conclusions: Our results confirm that parathyreoidectomy is the treatment of choice for patients with primary hyperparathyroidism. The ectopic position of the parathyroid gland in the mediastinum is associated with an increased risk of surgical failure. Most parathyroid lesions in the mediastinum can be safely removed from the cervical access.

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“…Recorded postoperative variables recorded included immediate postoperative complications, iCa, tCa, transient hypocalcemia (defined as serum tCa or iCa concentration lower than the institutional reference range at the time of discharge), calcium/vitamin D supplementation, histopathologic diagnosis, and survival time. Persistence of hypercalcemia from PHPT was defined as hypercalcemia that occurred within 6 months postoperatively, whereas recurrence of PHPT was defined as an elevated serum calcium level after 6 months of normocalcemia according to human medical literature …”

Section: Methodsmentioning

confidence: 99%

Perioperative characteristics, histological diagnosis, and outcome in cats undergoing surgical treatment of primary hyperparathyroidism

et al. 2019

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Objective: To report perioperative characteristics, complications, histopathologic diagnosis and outcome in cats undergoing surgical treatment for primary hyperparathyroidism (PHPT). Study design: Multi-institutional, retrospective case series. Animals: Thirty-two client-owned cats. Methods: Medical records of cats treated with surgical removal of 1 or more parathyroid gland(s) with confirmed histopathologic evaluation were reviewed. Cats were divided into preoperative ionized calcium (iCa) groups corresponding to the 33rd, 67th, and 100th percentiles of the preoperative iCa results of the study population. Follow-up consisted of phone conversation with owners or primary veterinarian. Results: Ionized calcium was above reference range in all cats (median 1.8 mmol/L [interquartile range, 1.5-1.9]). Abnormal tissue was excised after cervical exploration in all cats. The most common histopathologic diagnoses were parathyroid adenoma in 20 of 32 (62.5%) cats and parathyroid carcinoma in 7 of 32 (21.9%) cats. At discharge, 6 of 32 (18.8%) cats had hypercalcemia, 5 of 32 (15.6%) had hypocalcemia, and 21 of 32 (65.6%) were normocalcemic. Preoperative iCa did not correlate with postoperative iCa. The median follow-up time was 332 days (range, 7-3156). Overall median survival time was 1109 days (95% CI, 856-1332). Survival time was not associated with preoperative iCa group, hypocalcemia at discharge, hypercalcemia at discharge, or diagnosis of carcinoma. Conclusion: In this cohort of cats, parathyroid adenoma was the most common cause of PHPT, and surgical treatment resulted in very good median survival time. Preoperative iCa was not predictive of postoperative hypocalcemia. Clinical significance: Surgical parathyroidectomy for treatment of PHPT in cats provides a favorable prognosis.

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Delayed Calcium Normalization After Presumed Curative Parathyroidectomy is Not Associated with the Development of Persistent or Recurrent Primary Hyperparathyroidism

Cited by 8 publications

References 26 publications

Delayed Calcium Normalization after Successful Parathyroidectomy in Primary Hyperparathyroidism

Delayed Calcium Normalization after Successful Parathyroidectomy in Primary Hyperparathyroidism

Surgical Management of Primary Hyperparathyroidism—Clinicopathologic Study of 1019 Cases from a Single Institution

Perioperative characteristics, histological diagnosis, and outcome in cats undergoing surgical treatment of primary hyperparathyroidism

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