Vitamin D repletion in primary hyperparathyroid patients undergoing parathyroidectomy leads to reduced symptomatic hypocalcaemia and reduced length of stay: a retrospective cohort study

Acharya, Ravi; Kopczynska, Maja; C, Goodmaker; Mukherjee, Arijit; Doran, H

doi:10.1308/rcsann.2021.0078

Cited by 6 publications

(7 citation statements)

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“…У наших пациентов, принимавших колекальциферол, статистически значимо реже наблюдалась послеоперационная гипокальциемия по сравнению с пациентами, не принимавшими данный препарат. Результаты трех различных исследований сходны с нашими данными и подтверждают протективную роль нормальной концентрации 25(OH)D [ 7 ][ 21 ][ 22 ]. Исследование, проведенное Acharya и соавт., показало, что насыщение витамином D является значимым фактором, влияющим на симптомы гипокальциемии.…”

Section: Discussionunclassified

“…Исследование, проведенное Acharya и соавт., показало, что насыщение витамином D является значимым фактором, влияющим на симптомы гипокальциемии. Полученные результаты свидетельствуют о наличии статистически значимой ассоциации между насыщением витамином D и развитием гипокальциемии (ОШ=4,9 [ 95% ДИ: 1,8–13,7]) [ 7 ]. В исследовании Unsal и соавт.…”

Section: Discussionunclassified

“…Безусловно, послеоперационная гипокальциемия представляет собой многофакторное состояние, и помимо дефицита витамина D, свой вклад вносят такие важные факторы, как «синдром голодных костей», повреждение здоровых ОЩЖ и др. [ 7 ] Синдром «голодных костей» обычно развивается в ранний послеоперационный период у пациентов с тяжелыми костными проявлениями ПГПТ. Это связано с выраженным снижением уровня кальция в крови, которое происходит из-за устранения стимулирующего эффекта гиперпродукции ПТГ на остеокластическую резорбцию костей, что приводит к активному переходу кальция из крови в формирующуюся костную ткань.…”

Section: обоснованиеunclassified

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Association between preoperative cholecalciferol therapy and hypocalcemia after parathyroidectomy in patients with primary hyperparathyroidism

Elfimova,

Eremkina,

Rebrova

et al. 2024

Probl Endokrinol (Mosk)

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BACKGROUND: Primary hyperparathyroidism (PHPT) is a endocrine disorder characterized by excessive secretion of parathyroid hormone (PTH) from parathyroid gland tumors. Parathyroidectomy (PTE) is the main treatment for PHPT, but it can lead to hypocalcemia in up to 46% of cases. Hypocalcemia is associated with seizures and life-threatening cardiac arrhythmias, and vitamin D deficiency can exacerbate PHPT severity and contribute to «hungry bones syndrome,» resulting in severe and persistent postoperative hypocalcemia.AIM: To evaluate the association and determine the strength of the relationship between preoperative cholecalciferol therapy and the occurrence of hypocalcemia within 1–3 days after PTE in patients with PHPT.MATERIALS AND METHODS: The study was conducted at the Endocrinology Research Centre, during the periods of 1993–2010 and 2017–2020. The inclusion criteria consisted of patients diagnosed with PHPT who required PTE, had a serum 25-hydroxyvitamin D (25(OH)D) level below 20 ng/mL, and a serum total calcium level below 3 mmol/L. The exclusion criterion was the use of medications that affect calcium-phosphorus metabolism, including cinacalcet, denosumab, or bisphosphonates, either as monotherapy or as part of combination therapy.RESULTS: There were 117 patients, including 110 (94%) females and 7 (6%) males. The median age and interquartile range were 58 [49; 65] years. Among the participants, 21 (18%) received cholecalciferol supplementation for a duration of 2 weeks to 2 months prior to PTE, aiming to address vitamin D deficiency. The remaining 96 (82%) participants did not receive cholecalciferol supplementation. Both groups, i.e., participants receiving cholecalciferol and those who did not, were similar in terms of anthropometric factors (sex and age at the time of surgery), preoperative clinical characteristics (BMD decrease), and laboratory parameters (PTH, total calcium, phosphorus, ALP, OC, CTX-1, and 25(OH)D levels). The occurrence of postoperative hypocalcemia was significantly lower in participants who received cholecalciferol supplementation (10% vs. 63%, p<0,001, FET2). Cholecalciferol intake showed a negative association with hypocalcemia development (RR=0,15, 95% CI (0,03; 0,51)).CONCLUSION: Preoperative cholecalciferol supplementation for 2 weeks to 2 months before PTE reduces the risk of postoperative hypocalcemia in patients with PHPT by 2–33 times.

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Association between preoperative cholecalciferol therapy and hypocalcemia after parathyroidectomy in patients with primary hyperparathyroidism

Elfimova,

Eremkina,

Rebrova

et al. 2024

Probl Endokrinol (Mosk)

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“…It is important to note that patients in the study received calcitriol after surgery as part of standard postoperative care [ 48 ]. In a retrospective cohort study, it was found that vitamin D repletion in PHPT patients undergoing parathyroidectomy decreases hypocalcemia and reduces the length of hospital stay [ 61 ].…”

Section: Supplementation Of Vitamin D In Phptmentioning

confidence: 99%

Vitamin D Deficiency and the Presentation of Primary Hyperparathyroidism: A Mini Review

Yedla,

Kim,

Sharma

et al. 2023

International Journal of Endocrinology

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The clinical presentation of primary hyperparathyroidism (PHPT) has evolved over the years from a symptomatic disorder to a predominantly asymptomatic condition. Altered vitamin D metabolism seems to play a role in the presentation of PHPT and may exacerbate the severity of disease. The epidemiology of PHPT differs in the developing versus the developed world, where more severe phenotypes occur in regions where vitamin D deficiency is common. Although it has been validated that patients with PHPT should be vitamin D sufficient, the threshold to supplement in relation to the severity of PHPT and the degree of vitamin D deficiency remains controversial. This review will highlight some of the controversy regarding vitamin D deficiency and the different phenotypes of PHPT.

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“…The occurrence of these symptoms is the result of a rapid decline in PTH levels after surgery, after a long period of high PTH levels in PHPT ( 5 ). Vitamin D deficiency in preoperative patients leads to an increased probability of postoperative hypocalcemia ( 6 ).…”

Section: Introductionmentioning

confidence: 99%

Factors influencing serum calcium levels and the incidence of hypocalcemia after parathyroidectomy in primary hyperparathyroidism patients

Mu,

Zhao,

Zhao

et al. 2023

Front. Endocrinol.

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BackgroundParathyroidectomy (PTX) is an effective treatment for primary hyperparathyroidism (PHPT) patients. Postoperative hypocalcemia is a common complication after PTX. This study aimed to analyze the factors influencing serum calcium levels and the incidence of hypocalcemia after parathyroidectomy in primary hyperparathyroidism patients.MethodsThe retrospective study included 270 PHPT patients treated with PTX and collected their demographic and clinical information and their laboratory indices. Factors influencing serum calcium levels and hypocalcemia after PTX in PHPT patients were analyzed using univariate and multifactorial analyses.ResultsFirst, in patients with normal preoperative serum calcium levels (2.20–2.74 mmol/L), the higher the preoperative alkaline phosphatase and serum phosphorus levels, the lower the postoperative serum calcium levels. Furthermore, the higher the preoperative serum calcium levels and the accompanying clinical symptoms, the higher the postoperative serum calcium levels. Low preoperative serum calcium levels were shown to be a risk factor for postoperative hypocalcemia (OR=0.022), and the optimal preoperative serum calcium threshold was 2.625 mmol/L (sensitivity and specificity were 0.587 and 0.712, respectively). Second, in the mild preoperative hypercalcemia group (2.75-3.00 mmol/L), the older the patient, the higher the preoperative and postoperative serum calcium levels, the higher the postoperative serum calcium; the lower the alkaline phosphatase and calcitonin levels, the higher the postoperative serum calcium levels. On the other hand, the younger the patient was, the more likely hypocalcemia blood was (OR=0.947), with an optimal age threshold of 47.5 years (sensitivity and specificity were 0.543 and 0.754, respectively). Third, in the preoperative moderate to severe hypercalcemia group (>3.0mmol/L), patients undergoing a combined contralateral thyroidectomy and a total thyroidectomy had low postoperative serum calcium levels.ConclusionPatients with different preoperative serum calcium levels had various factors influencing their postoperative serum calcium levels and postoperative hypocalcemia, which facilitated the assessment of their prognosis.

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Vitamin D repletion in primary hyperparathyroid patients undergoing parathyroidectomy leads to reduced symptomatic hypocalcaemia and reduced length of stay: a retrospective cohort study

Cited by 6 publications

References 30 publications

Association between preoperative cholecalciferol therapy and hypocalcemia after parathyroidectomy in patients with primary hyperparathyroidism

Association between preoperative cholecalciferol therapy and hypocalcemia after parathyroidectomy in patients with primary hyperparathyroidism

Vitamin D Deficiency and the Presentation of Primary Hyperparathyroidism: A Mini Review

Factors influencing serum calcium levels and the incidence of hypocalcemia after parathyroidectomy in primary hyperparathyroidism patients

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