Elevated parathyroid hormone levels after successful parathyroidectomy for primary hyperparathyroidism: a clinical review

Llamas, Roberto de la Plaza; Ángel, José Manuel Ramia; Peralta, Vladimir Arteaga; Amador, Cristina García; Marcano, Aylhín Joana López; Velasco, Aníbal Armando Medina; Sierra, Begoña Gónzalez; Vázquez, Alba Manuel; Fragua, Raquel Aránzazu Latorre

doi:10.1007/s00405-017-4836-9

Cited by 29 publications

(25 citation statements)

References 41 publications

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“…Among the etiologies proposed for the phenomenon of normocalcemic‐elevated hyperparathyroidism in the literature are physiological variation in the PTH due to relative postoperative hypocalcemia, vitamin D deficiency, a drop in the glomerular filtration rate (GFR), altered calcium‐sensing receptors in the remaining glands leading to a higher set point for PTH secretion, reduced peripheral sensitivity to PTH, and renal calcium leakage. 19 A statistically significant correlation between PTH postsurgery and other demographic or clinical characteristics, including vitamin D, calcium, and phosphorus levels, was not found in our study.…”

Section: Discussioncontrasting

confidence: 82%

High parathyroid hormone levels after parathyroidectomy for parathyroid adenoma are not related to the cellularity of the remaining glands

Sagiv

Delgado

Sadeh

et al. 2021

Laryngoscope Investig Oto

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Background: Patients with primary hyperparathyroidism (PHPT) treated surgically occasionally have normalized calcium, but persistently high parathyroid hormone (PTH). We hypothesized that a possible explanation for this phenomenon is an underlying hyperplasia rather than adenoma.Methods: Retrospective cohort of patients who underwent parathyroidectomy for PHPT with biopsy of a normal-appearing parathyroid gland were included. Cellularity level of each biopsy and of the adenoma's rim was determined.Results: Forty-seven patients were included. Of them, 19 (40%) had postoperative normocalcemia but elevated PTH. There was no correlation between cellularity either in the rim or of the normal-appearing parathyroid gland and postoperative PTH. The postoperative high PTH group had higher preoperative PTH (P = 0.001) and larger adenomas (P = 0.025).Conclusions: High PTH levels after successful parathyroidectomy in patients with primary hyperparathyroidism do not appear to result from underlying hyperplasia. A possible alternative explanation is that these patients have a higher preoperative burden of disease.cellularity, elevated PTH levels, parathyroid adenoma, parathyroid hyperplasia, parathyroidectomy | INTRODUCTIONPrimary hyperparathyroidism (PHPT) is diagnosed by an elevated parathyroid hormone (PTH) concentration in patients with hypercalcemia and hypercalciuria. Its most common clinical presentation is asymptomatic hypercalcemia. 1 It is recommended that patients with symptomatic PHPT (nephrolithiasis, symptomatic hypercalcemia) have parathyroid surgery, which is the only definitive therapy. 2,3 In some patients with asymptomatic disease, surgery is not mandatory. However, this is disputed as some claim that a truly asymptomatic PHPT patient is quite rare. 4 Whereas most asymptomatic patients do not exhibit disease progression, as defined by worsening hypercalcemia,

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Section: Discussioncontrasting

confidence: 82%

High parathyroid hormone levels after parathyroidectomy for parathyroid adenoma are not related to the cellularity of the remaining glands

Sagiv

Delgado

Sadeh

et al. 2021

Laryngoscope Investig Oto

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“…Postoperative hyperparathyroidism is not an uncommon finding after parathyroidectomy for classical PHPT, with a mean prevalence of 23.5% among various studies, mostly related to vitamin D deficiency or insufficiency or lack of Ca through diet or supplements. ( 58 ) As opposed to PHPT where this finding invariably represents a form of secondary hyperparathyroidism because the Ca normalizes, elevated PTH levels found after surgery for NHPT may be the only sign of disease persistence, possibly hinting at a previously unidentified cause of secondary hyperparathyroidism involving multiple glands. Another study showed a mild (2.3% ± 5.0%), but significant increase in lumbar spine BMD in NHPT patients undergoing successful parathyroidectomy.…”

Section: Surgical and Medical Outcomesmentioning

confidence: 99%

Normocalcemic Hyperparathyroidism: A Heterogeneous Disorder Often Misdiagnosed?

Zavatta

Clarke

2020

JBMR Plus

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Normocalcemic primary hyperparathyroidism (NHPT) was first described over 10 years ago, but uncertainties still remain about its definition, prevalence, and rates of complications. As a result, consensus management guidelines for this condition have not yet been published. Several hypotheses have been proposed for the pathophysiology of NHPT, but it may be a heterogeneous disorder with multiple causes, rather than a single etiology that explains this biochemical phenotype. A common clinical concern is whether NHPT should be treated surgically when complications are already present at first recognition of the disorder, rather than following patients clinically over time. The literature on NHPT is based mostly on larger studies of population‐based cohorts and smaller studies from referral centers. Lack of rigorous diagnostic criteria and selection bias inherent in populations seen at tertiary referral centers may explain the heterogeneity of reported rates of bone and renal complications in relation to consistently mild laboratory alterations. Unresolved questions remain about the significance of NHPT when it is diagnosed biochemically without evident bone or kidney complications. Moreover, its natural history remains to be elucidated because a proportion of what is classified as NHPT may revert to normal spontaneously, thus revealing previously unrecognized secondary hyperparathyroidism. These issues indicate that caution should be used in recommending surgery for NHPT. This review will focus on recent issues regarding the pathophysiology, evaluation, and management of NHPT. © 2020 The Authors. JBMR Plus published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research.

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“…Vitamin D deficiency, a decrease in the glomerular filtration rate, the relative drop in postoperative calcium, the presence of hungry bone syndrome, and altered peripheral sensitivity to PTH have been proposed as possible mechanisms. 9 In a recent study by Caldwell et al, 10 approximately one third of the adult patients who underwent parathyroidectomy had persistent elevation of PTH level. Interestingly, this was associated with lower, but not abnormal, preoperative vitamin 25(OH)D levels compared with the group with normal postoperative PTH levels (26 ± 15 pg/mL vs 36 ± 11 pg/mL).…”

Section: Discussionmentioning

confidence: 95%

“…In a review published in 2017, 33 studies reported data on this phenomenon, with a mean prevalence of 23.5% among postoperative cases. 9 There is no reported association with primary hyperparathyroidism recurrence. 9 Its etiology is not fully understood, and it is considered to be multifactorial.…”

Section: Discussionmentioning

confidence: 99%

“…9 There is no reported association with primary hyperparathyroidism recurrence. 9 Its etiology is not fully understood, and it is considered to be multifactorial. Vitamin D deficiency, a decrease in the glomerular filtration rate, the relative drop in postoperative calcium, the presence of hungry bone syndrome, and altered peripheral sensitivity to PTH have been proposed as possible mechanisms.…”

Section: Discussionmentioning

confidence: 99%

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Ectopic Parathyroid Adenoma in an 11-Year-Old Girl: Case Report and Literature Review

Flokas

Ganieva

Grieco

et al. 2021

AACE Clinical Case Reports

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Objective Primary hyperparathyroidism secondary to an ectopic parathyroid adenoma is rare among children and adolescents. Methods We describe the case of an 11-year-old girl with incidentally diagnosed primary hyperparathyroidism secondary to an intrathymic parathyroid adenoma and performed a review of the related literature. Results 99m Technetium sestamibi single-photon emission computerized tomography/computed tomography and 4-dimensional computed tomography confirmed the ectopic location of the adenoma. The patient underwent thoracoscopic thymectomy and remained normocalcemic with elevated parathyroid hormone showing a downward trend. Parathyroid hormone normalized 18 months after successful parathyroidectomy. Conclusion We review the case of a rare mediastinal parathyroid adenoma in a pediatric patient and summarize the epidemiologic profile, diagnosis, and management of similar pediatric cases.

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Elevated parathyroid hormone levels after successful parathyroidectomy for primary hyperparathyroidism: a clinical review

Abstract: The prevalence of NCePTH is high. The causes of secondary hyperparathyroidism should be investigated carefully. Patients require treatment and long-term follow-up.

Cited by 29 publications

References 41 publications

High parathyroid hormone levels after parathyroidectomy for parathyroid adenoma are not related to the cellularity of the remaining glands

High parathyroid hormone levels after parathyroidectomy for parathyroid adenoma are not related to the cellularity of the remaining glands

Normocalcemic Hyperparathyroidism: A Heterogeneous Disorder Often Misdiagnosed?

Ectopic Parathyroid Adenoma in an 11-Year-Old Girl: Case Report and Literature Review

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