Serum parathyroid hormone and alkaline phosphatase as predictors of calcium requirements after total parathyroidectomy for hypocalcemia in secondary hyperparathyroidism

Ge, Pingjiang; Liu, Shuangxin; Sheng, Xiaoli; Li, Sijia; Xu, Mimi; Jiang, Jie; Chen, Shaohua

doi:10.1002/hed.24965

Cited by 13 publications

(13 citation statements)

References 9 publications

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“…In our study, patients in the SH group had a higher preoperative iPTH level than did the non-SH group (2,304.9 vs. 1,239.7 pg/mL). e results were consistent with previous studies [31][32][33].…”

Section: International Journal Of Endocrinologysupporting

confidence: 94%

Risk Factors for Severe Hypocalcemia in Patients with Secondary Hyperparathyroidism after Total Parathyroidectomy

Wen

Zhao

et al. 2021

International Journal of Endocrinology

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Background. Hypocalcemia is the most common complication of total parathyroidectomy in secondary hyperparathyroidism (SHPT) and is associated with adverse consequences such as spasms, epilepsy, and arrhythmia and even death if the serum calcium level decreases rapidly. Previous studies have identified several risk factors for postoperative severe hypocalcemia (SH) in patients with SHPT, but the sample sizes were small and thus the results may not be reliable. Objectives. This study was performed to investigate the risk factors for SH after total parathyroidectomy without autotransplantation (tPTX) in a large sample of patients with uremic hyperparathyroidism. Methods. We retrospectively investigated the records of 1,095 patients with SHPT treated with tPTX between January 2008 and December 2018. Based on the postoperative serum calcium concentration, the patients were grouped into SH and non-SH groups. The clinical characteristics and biochemical results were analyzed, and binary logistic regression analysis was used to identify the risk factors for SH. Results. After surgery, 25.9% of the patients developed SH. Age, diastolic blood pressure (DBP), heart rate, frequency of bone pain, weight of resected glands, preoperative serum calcium, intact parathyroid hormone (iPTH), alkaline phosphatase (ALP), and hemoglobin levels differed between the two groups. Binary logistic regression analyses identified preoperative serum calcium, iPTH, and ALP levels as independent predictors of SH after surgery. Conclusions. The preoperative serum calcium, iPTH, and ALP levels can be used to assess the risk of postoperative SH in patients with SHPT. Such patients should thus be monitored closely in order to initiate prompt interventions to avoid SH.

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Section: International Journal Of Endocrinologysupporting

confidence: 94%

Risk Factors for Severe Hypocalcemia in Patients with Secondary Hyperparathyroidism after Total Parathyroidectomy

Wen

Zhao

et al. 2021

International Journal of Endocrinology

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“…Various risk factors have been suggested for the development of postoperative hypocalcemia in previous studies, including younger age, pruritus, higher preoperative iPTH and ALP levels, and lower preoperative serum calcium level. Moreover, the diagnostic value of these factors was evaluated by using receiver operator characteristic (ROC) analyses [ 31 , 33 , 40 , 41 ]. For example, one study reported a diagnostic model incorporated 3 factors (preoperative serum calcium, iPTH, and ALP levels) in the risk estimation of SH [ 40 ].…”

Section: Discussionmentioning

confidence: 99%

“…In previous studies, preoperative iPTH as one of the risk factors of postoperative hypocalcemia has been frequently found in patients who underwent PTX [ 29 , 31 – 34 , 36 , 37 , 39 , 40 , 43 , 44 ]. It is well accepted that preoperative iPTH concentration can be used to predict postoperative hypocalcemia, because it is consistent with the physiological functions of iPTH.…”

Section: Discussionmentioning

confidence: 99%

“…Importantly, we developed a nomogram which achieved an optimal preoperative prediction of SH in those patients who underwent TPTX without auto-transplantation for secondary hyperparathyroidism. Considering the high incidence of SH after parathyroidectomy and the development of life-threatening sequelae, eforts on the risk estimation of SH have been made over the past decade [29][30][31][32][33][34][35][36][37][38][39][40][41][42][43][44][45][46]. Various risk factors have been suggested for the development of postoperative hypocalcemia in previous studies, including younger age, pruritus, higher preoperative iPTH and ALP levels, and lower preoperative serum calcium level.…”

Section: Discussionmentioning

confidence: 99%

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Risk Factor Analysis and Prediction of Severe Hypocalcemia after Total Parathyroidectomy without Auto-Transplantation in Patients with Secondary Hyperparathyroidism

Zhang

et al. 2023

International Journal of Endocrinology

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Objective. Our study aimed to develop and validate a nomogram to predict severe hypocalcemia (SH) before total parathyroidectomy (TPTX) without auto-transplantation in patients with secondary hyperparathyroidism. Methods. A total of 299 consecutive patients who underwent TPTX without transplantation for secondary hyperparathyroidism were selected from the General Hospital of Northern Theater Command between January 2013 and December 2021. Of these, patients who underwent surgery between January 2013 and December 2020 formed the training cohort (n = 208) to develop a nomogram, and those who underwent surgery thereafter formed the validation cohort (n = 91) to validate the performance of this nomogram. Univariate and multivariate logistic regression analyses were used to identify the risk factors associated with SH, and then, a nomogram was constructed. Results. The incidence of postoperative SH was 27.9% and 35.2% in the training and validation cohorts, respectively. The preoperative factors associated with SH were younger age, lower serum calcium (Ca) level, higher intact parathyroid hormone (iPTH) level, and higher serum alkaline phosphatase (ALP) level. Incorporating these 4 factors, the nomogram achieved good concordance indexes of 0.866 (95%CI, 0.816–0.916) and 0.867 (95% CI, 0.793–0.941) in predicting SH in the training and validation cohorts, respectively, and had well-fitted calibration curves. The positive predictive values of the nomogram were 64.7% (54.1%–78.4%) and 75.0% (58.6%–88.5%), and negative predictive values of the nomogram were 90.0% (82.9%–93.6%) and 86.4% (73.5%–94.0%) for the training and validation cohorts, respectively. Conclusions. We developed and validated a nomogram for the prediction of SH in patients who underwent TPTX without auto-transplantation for secondary hyperparathyroidism. Our nomogram may facilitate the identification of high-risk SH in patients after TPTX and optimization of preoperative decision-making.

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“…For parathyroid autotransplantation, we selected the last hyperplastic parathyroid gland. The glands (60-100 mg) were cut into 25-30 particles around 1 mm diameter in size and were transplanted into the surface of the brachioradialis muscle of the arm [15][16][17]. For patients with hypocalcemia (< 2.1 mmol/L), we added the dose of the calcium supplement.…”

Section: Surgical Treatment Groupmentioning

confidence: 99%

Treatment of Uremic Tumoral Calcinosis in Maintenance Hemodialysis Patients

Cui

et al. 2020

Blood Purif

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Background/Aims: Uremic tumoral calcinosis (UTC) is a rare disease with metastatic tissue calcification in maintenance hemodialysis (HD) patients. However, limited data are available on the treatment of UTC in HD patients. This article mainly discusses the diagnostic findings and efficacy of treatment on HD patients with UTC. Methods: A retrospective analysis was conducted based on the data of 13 cases of UTC, including their clinical features, biochemical indicators, imaging findings, diagnosis, therapeutic methods, and follow-up results. Parathyroidectomy (PTX) or drug treatment was determined based on intact parathyroid hormone (iPTH) levels and clinical symptoms. Results: All 13 patients were diagnosed as UTC definitely by imaging examination. The predominant areas involved were the buttocks (4 cases, 30.77%), shoulders (4 cases, 30.77%), and elbows (3 cases, 23.08%). Based on the levels of iPTH, cases were categorized into 2 different groups: PTX treatment group was associated with high levels of iPTH, while drug treatment group (lanthanum carbonate or sevelamer with sodium thiosulfate) was associated with lower iPTH levels. After PTX treatment, there was a significant decrease in serum iPTH, calcium (Ca), phos-G.K., S.L., and Y.C. co-first authors.

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Serum parathyroid hormone and alkaline phosphatase as predictors of calcium requirements after total parathyroidectomy for hypocalcemia in secondary hyperparathyroidism

Abstract: The preoperative PTH and alkaline phosphatase levels can predict postoperative calcium requirements, such that equations of calcium supplement allow the management of hypocalcemia efficiently in patients on dialysis after parathyroidectomy with autotransplantation.

Cited by 13 publications

References 9 publications

Risk Factors for Severe Hypocalcemia in Patients with Secondary Hyperparathyroidism after Total Parathyroidectomy

Risk Factors for Severe Hypocalcemia in Patients with Secondary Hyperparathyroidism after Total Parathyroidectomy

Risk Factor Analysis and Prediction of Severe Hypocalcemia after Total Parathyroidectomy without Auto-Transplantation in Patients with Secondary Hyperparathyroidism

Treatment of Uremic Tumoral Calcinosis in Maintenance Hemodialysis Patients

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