Reelevation of parathyroid hormone level after parathyroidectomy in patients with primary hyperparathyroidism: Importance of decreased renal parathyroid hormone sensitivity

Yamashita, Hiroyuki; Noguchi, Shiro; Moriyama, Taiki; Takamatsu, Yuji; Sadanaga, Kyoko; Uchino, Shigehiko; Watanabe, Shin; Ogawa, Takahiro

doi:10.1016/j.surg.2004.12.009

Cited by 32 publications

(24 citation statements)

References 31 publications

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“…In our series, the incidence of eucalcemic PTH elevation at 6 months was 39.1%, and this appeared consistent to those previously reported 6–11,14–17. Similar to other studies, although postoperative PTH tends to slowly normalize over time, it also fluctuates 7,12. Over the first 2 years, only 78 patients (48.4%) maintained normal PTH levels throughout the entire cohort.…”

Section: Discussionsupporting

confidence: 92%

“…Although age and 25OHD 3 would seem interrelated as the latter tends to decrease with age, our data seemed to support the hypothesis that preexisting vitamin D deficiency is a possible cause of postoperative ePTH. This is consistent with previous studies 7,13,19,20. The implication is that perhaps patients with advanced age or with low preoperative 25OHD 3 may benefit from a course of vitamin D supplementation after surgery.…”

Section: Discussionsupporting

confidence: 92%

“…In the univariate analysis of preoperative factors, similar to previous studies, advanced age, higher PTH, higher creatinine, heavier adenoma, and low 25OHD 3 were significantly associated with ePTH; in the multivariable analysis, advanced age and low 25OHD 3 were factors independently associated with ePTH at 6 months 7–9,11,12,17,18. Although age and 25OHD 3 would seem interrelated as the latter tends to decrease with age, our data seemed to support the hypothesis that preexisting vitamin D deficiency is a possible cause of postoperative ePTH.…”

Section: Discussionsupporting

confidence: 81%

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Eucalcemic Parathyroid Hormone Elevation After Parathyroidectomy for Primary Sporadic Hyperparathyroidism: Risk Factors, Trend, and Outcome

Lang

Wong

et al. 2011

Ann Surg Oncol

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BackgroundPatients with eucalcemic parathyroid hormone elevation (ePTH) after parathyroidectomy for primary hyperparathyroidism (HPT) may be at risk of recurrence. We aimed to examine risk factors, trend of PTH level, and outcome of patients with ePTH 6 months after parathyroidectomy.MethodsA total of 161 primary HPT were analyzed. The 6-month postoperative calcium and PTH levels were obtained. ePTH was defined as an elevated PTH level in the presence of normocalcemia. At 6 months, 98 had eucalcemic normal PTH and 63 (39.1%) had ePTH. Perioperative variables, PTH trend, and outcome were compared between 2 groups. Multivariable analyses were performed to identify independent preoperative and operative/postoperative risk factors for ePTH.ResultsAmong preoperative factors, advanced age (odds ratio [OR] = 1.042, P = .027) and low 25-hydroxyvitamin D3 (25OHD3) (OR = 1.043, P = .009) were independently associated with ePTH, whereas among operative/postoperative factors, high 10-min intraoperative PTH level (OR = 1.015, P = .040) and high postoperative 3-month PTH (OR = 1.048, P < .001) were independently associated with ePTH. After a mean follow-up of 38.7 months, recurrence rate was similar between the 2 groups (P = 1.00). In the first 2 postoperative years, 75 (46.6%) had ePTH on at least 1 occasion and 8 (5.0%) had persistently ePTH on every occasion.ConclusionsAdvanced age, low 25OHD3, high 10-min intraoperative PTH, and high postoperative 3-month PTH were independently associated with ePTH at 6-month. Although 39.1% of patients had ePTH at 6 months, more than 50% had at least 1 ePTH within the first 2 years of follow-up. Recurrence appeared similar between those with or without ePTH at 6 months.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionsupporting

confidence: 92%

Section: Discussionsupporting

confidence: 81%

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Eucalcemic Parathyroid Hormone Elevation After Parathyroidectomy for Primary Sporadic Hyperparathyroidism: Risk Factors, Trend, and Outcome

Lang

Wong

et al. 2011

Ann Surg Oncol

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“…Ebenfalls einen postoperativen 1,25Di hydroxicholecalciferolMangel beschreibt Dhillon [9] (wenn renale und ossäre Pati enten exkludiert werden) aufgrund einer reversiblen Resistenz der Nieren gegen über der durch PTH vermittelten 1αHy droxilierung von 25(OH)VitaminD3. Auch Yamashita [33] diskutiert eine renale Resistenz für Parathormon, vor allem bei Patienten mit VitaminDMangel oder re naler Insuffizienz. Auch eine vorbestehen de VitaminDResistenz kann eine seltene Ursache sein, bei der kein primärer, son dern ein tertiärer Hyperparathyreoidis mus vorliegt und der postoperativ wieder zu einem sekundären Hyperparathyreoi dismus wird.…”

Section: Schweregrad Des Phpt Und Größe Des Nebenschilddrüsenadenomsunclassified

Primärer Hyperparathyreoidismus

Hermann¹

2009

Chirurg

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A review of the literature revealed that late postoperative elevated parathyroid hormone levels after successful pHPT surgery occur in 21.5%. Multiple causes are discussed, e.g. reactive hyperparathyroidism in cases of relative hypocalcemia, hungry bone syndrome, vitamin D deficiency, renal dysfunction and ethnic or lifestyle differences. In mild cases of postoperative hyperparathyrinemia observation of the patient may be sufficient. In cases of reactive hyperparathyroidism due to hypocalcemia, administration of calcium is indicated, in symptomatic patients, additional administration of vitamin D or calcitriol is necessary. Vitamin D deficiency per se needs adequate substitution. In cases of ongoing hyperparathyrinemia an interdisciplinary diagnostic and therapeutic approach is required.

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“…Furthermore, the importance of postoperatively elevated iPTH levels remains unclear. Yamashita et al [7] highlighted the impaired renal sensitivity of PTH to play a role in postoperative PTH elevation following surgery for pHPT, with consequences transferable to sHPT. They proposed an index of PTH to nephrogenous cyclic adenosine monophosphate ratio for indication of renal resistance to PTH.…”

mentioning

confidence: 99%

Will intra-operative measurement of parathyroid hormone alter the surgical concept of renal hyperparathyroidism?

Lorenz

Dralle

2005

Langenbecks Arch Surg

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Reelevation of parathyroid hormone level after parathyroidectomy in patients with primary hyperparathyroidism: Importance of decreased renal parathyroid hormone sensitivity

Cited by 32 publications

References 31 publications

Eucalcemic Parathyroid Hormone Elevation After Parathyroidectomy for Primary Sporadic Hyperparathyroidism: Risk Factors, Trend, and Outcome

Eucalcemic Parathyroid Hormone Elevation After Parathyroidectomy for Primary Sporadic Hyperparathyroidism: Risk Factors, Trend, and Outcome

Primärer Hyperparathyreoidismus

Will intra-operative measurement of parathyroid hormone alter the surgical concept of renal hyperparathyroidism?

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