Persistent elevation of parathormone levels after surgery for primary hyperparathyroidism

Kota, Sunil Kumar; Kota, Siva Krishna; Jammula, Sruti; Bhargav, Panchangam Ramakanth; Sahoo, Abhay Kumar; Das, Sambit; Talluri, Satish C; Kongara, Srikanth; Krishna, SV S; Modi, Kirtikumar D

doi:10.4103/ijem.ijem_212_20

Cited by 5 publications

(2 citation statements)

References 49 publications

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“…Persistent hyperparathyroidism (P-HPT) is defined as the condition where calcium either does not return to normal values or rises again within 6 mo of the initial parathyroidectomy for pHPT[ 8 ]. It is mainly due to failure to remove an overactive parathyroid (adenoma or unrecognized parathyroid hyperplasia)[ 8 , 10 , 11 ]. Recurrent hyperparathyroidism (R-HPT) occurs when calcium increases beyond normal limits after at least 6 mo of normal values after the initial parathyroidectomy for pHPT.…”

Section: Introductionmentioning

confidence: 99%

Update on the current management of persistent and recurrent primary hyperparathyroidism after parathyroidectomy

Pavlidis¹,

Pavlidis²

2023

World J Clin Cases

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Primary hyperparathyroidism (pHPT) is the third most common endocrine disease. The surgical procedure aims for permanent cure, but recurrence has been reported in 4%-10% of pHPT patients. Preoperative localization imaging is highly valuable. It includes ultrasound, computed tomography (CT), single-photon-emission CT, sestamibi scintigraphy and magnetic resonance imaging. The operation has been defined as successful when postoperative continuous eucalcemia exists for more than the first six months. Ongoing hypercalcemia during this period is defined as persistence, and recurrence is defined as hypercalcemia after six months of normocalcemia. Vitamin D is a crucial factor for a good outcome. Intraoperative parathyroid hormone (PTH) monitoring can safely predict the outcomes and should be suggested. PTH ≤ 40 pg/mL or the traditional decrease ≥ 50% from baseline minimizes the likelihood of persistence. Risk factors for persistence are hyperplasia and normal parathyroid tissue on histopathology. Risk factors for recurrence are cardiac history, obesity, endoscopic approach and low-volume center (at least 31 cases/year). Cases with double adenomas or four-gland hyperplasia have a greater likelihood of persistence/ recurrence. A 6-mo calcium > 9.7 mg/dL and eucalcemic parathyroid hormone elevation at 6 mo may be associated with recurrence necessitating long-term follow-up. 18F-fluorocholine positron emission tomography and 4-dimensional CT in persistent and recurrent cases can be valuable before reoperation. With these novel advances in preoperative imaging and localization as well as intraoperative PTH measurement, the recurrence rate has dropped to 2.5%-5%. Six-month serum calcium ≥ 9.8 mg/dL and parathyroid hormone ≥ 80 pg/mL indicate a risk of recurrence. Negative sestamibi scintigraphy, diabetes and elevated osteocalcin levels are predictors of multiglandular disease, which brings an increased risk of persistence and recurrence. Bilateral neck exploration was considered the gold-standard diagnostic method. Minimally invasive parathyroidectomy and neck exploration are both effective surgical techniques. Multidisciplinary diagnostic and surgical management is required to prevent persistence and recurrence. Long-term follow-up, even up to 10 years, is necessary.

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Section: Introductionmentioning

confidence: 99%

Update on the current management of persistent and recurrent primary hyperparathyroidism after parathyroidectomy

Pavlidis¹,

Pavlidis²

2023

World J Clin Cases

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“…[4][5] A study from India reported PPTH elevation 30% of patients for several years post parathyroid adenectomy. 6 Several factors have been implicated for this persistent elevation of PTH, including low vitamin D (vit-D) levels, impaired renal function, a secondary response to bone remineralization, ectopic gland location, errors in frozen section, in-experienced surgeon, presence of persistent disease and development of another autonomous Conflict of interest: The authors declared no conflict of interest exists. Citation: Ahsan T, Ghaus S, Pal KMI, Erum U, Jabeen R. Persistently elevated parathyroid hormone level after curative parathyroidectomy in patients with primary hyperparathyroidism.…”

Section: Introductionmentioning

confidence: 99%

Persistently Elevated Parathyroid Hormone Level after Curative Parathyroidectomy in Patients with Primary Hyperparathyroidism

Ahsan,

Ghaus,

Inam Pal

et al. 2023

J Fatima Jinnah Med Univ

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Background: Persistent elevation of parathyroid hormone (PPTH) levels following curative parathyroidectomy is a dynamic & multifactorial process. This study was designed to study the frequency of persistent hyperparathyroidism in our patients and to identify the potential causal factors for persistent PTH elevation following parathyroidectomy. Methodology: The study included prospectively collected data on post-operative patients of primary hyperparathyroidism who underwent parathyroidectomy from 2004-2018. Data was analyzed by SPSS version-21. For descriptive statistics, frequency and percentages were calculated, while mean ±standard deviation were calculated for age, duration of disease, pre-operative and post-operative biochemical parameters, like serum PTH, calcium and vitamin D levels. Results: A total of 11 (39.3%) patients, were diagnosed as persistent hyperparathyroidism, out of the 30 patients, who underwent parathyroidectomy. All patients were female with a mean age of 45.27+17.2 years and a mean duration of symptoms of 21.3 months. The mean post-operative PTH level, vitamin D and calcium were 154.04±78.64 pg/ml, 22.28±13.79 ng/ml 9.46±0.79 mg/dl, respectively. Fluctuation of PTH hormone in relation to erratic vitamin D intake was reported in 8 patients, and recurrent parathyroid adenoma was reported in three patients, which was subsequently re-operated. Conclusion: Adequate vitamin D supplementation is essential in the pre and post-operative period to prevent persistent parathyroid stimulation and possible dysregulation. Surveillance for recurrence of hyperparathyroidism should be maintained long term.

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Persistent elevated serum parathyroid hormone levels with normocalcaemia after parathyroidectomy: Secondary hyperparathyroidism or pseudo- hyperparathyroidism?

Benet-Muñoz,

Acosta-Mérida,

Casimiro-Pérez

et al. 2024

Cirugía Española (English Edition)

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Persistent elevation of parathormone levels after surgery for primary hyperparathyroidism

Cited by 5 publications

References 49 publications

Update on the current management of persistent and recurrent primary hyperparathyroidism after parathyroidectomy

Update on the current management of persistent and recurrent primary hyperparathyroidism after parathyroidectomy

Persistently Elevated Parathyroid Hormone Level after Curative Parathyroidectomy in Patients with Primary Hyperparathyroidism

Persistent elevated serum parathyroid hormone levels with normocalcaemia after parathyroidectomy: Secondary hyperparathyroidism or pseudo- hyperparathyroidism?

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