Early biochemical response to parathyroidectomy for primary hyperparathyroidism and its predictive value for recurrent hypercalcemia and recurrent primary hyperparathyroidism

Ryder, C. Yoonhee; Jarocki, Adrienne; McNeely, Molly M.; Currey, Erin Lee; Miller, Barbra S.; Cohen, Mark S.; Gauger, Paul G.; Hughes, David T.

doi:10.1016/j.surg.2020.05.049

Cited by 13 publications

(19 citation statements)

References 15 publications

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“…Patients with a partial biochemical response after parathyroidectomy have a greater risk of recurrent hypercalcemia compared to those with complete biochemical response. The postoperative presence of persistently increased PTH but normocalcemia or persistently increased calcium but normal PTH increases 1.6 and 2 times, respectively, the risk of recurrent hypercalcemia [ 10 ]. Despite these data, there has been no demonstration of the association between transient hypercalcemia after parathyroidectomy and persistent or recurrent PHPT [ 6 ].…”

Section: Discussionmentioning

confidence: 99%

Delayed Calcium Normalization after Successful Parathyroidectomy in Primary Hyperparathyroidism

Rodríguez

Montesinos

Rodríguez-Delgado

et al. 2021

Case Reports in Endocrinology

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Introduction. Parathyroidectomy is the curative treatment option in primary hyperparathyroidism (PHPT). The decrease of parathormone (PTH) by 50% or more from levels prior to surgery after excision predicts successful parathyroidectomy. Serum calcium is expected to return to normal within 24–72 hours after the surgery; however, nearly 10% have transient, persistent postoperative hypercalcemia. We present a case report of delayed calcium normalization after successful parathyroidectomy in a 38-year-old patient with PHPT. Methods. Parathyroidectomy was performed, with evidence of a decrease in PTH levels of more than 50% in the first 24 hours postoperatively compared to presurgical PTH; however, despite curative parathyroidectomy, a delayed calcium normalization was evidenced, with hypercalcemia persistence up to 120 hours postoperatively. Results. After the first month postoperatively, serum calcium remained normal. In conclusion, approximately 10% of patients with curative parathyroidectomy have transient, persistent postoperative hypercalcemia, which is more likely to occur in patients with higher preoperative serum calcium and PTH levels. Conclusion. Persistent hypercalcemia after the first month postoperatively is related with persistent PHPT, highlighting the importance of calcium monitoring after parathyroidectomy to predict short-term, medium-term, and long-term outcomes and prognosis.

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Section: Discussionmentioning

confidence: 99%

Delayed Calcium Normalization after Successful Parathyroidectomy in Primary Hyperparathyroidism

Rodríguez

Montesinos

Rodríguez-Delgado

et al. 2021

Case Reports in Endocrinology

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“…There are only few data on the epidemiology of recurrent PHPT. Most authorities consider prevalence between 2.5 and 9.8% (73). Importantly, as recurrent PHPT can occur many years after initial presentation and predictive factors for recurrence are insufficiently sensitive, long-term yearly monitoring of calcium concentrations after initially successful parathyroid surgery is recommended (74).…”

Section: Q5 What Is the Definition Prevalence And Causes Of Recurrent...mentioning

confidence: 99%

“…It is not, however, consistently associated with an increased risk of recurrent PHPT (75). Although elevated PTH has been associated with recurrence in some series (73,78,79), it is not sufficiently discriminatory to recommend routine monitoring (i.e. most individuals with elevated PTH will not have recurrence of the disease).…”

Section: Q6 Do We Need To Act Upon Persistent Elevations Of Pth Level...mentioning

confidence: 99%

European expert consensus on practical management of specific aspects of parathyroid disorders in adults and in pregnancy: recommendations of the ESE Educational Program of Parathyroid Disorders (PARAT 2021)

Bollerslev

Rejnmark

Zahn

et al. 2022

European Journal of Endocrinology

105

125

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This European expert consensus statement provides recommendations for the diagnosis and management of primary hyperparathyroidism (PHPT), chronic hypoparathyroidism in adults (HypoPT), and parathyroid disorders in relation to pregnancy and lactation. Specified areas of interest and unmet needs identified by experts at the second ESE Educational Program of Parathyroid Disorders (PARAT) in 2019, were discussed during two virtual workshops in 2021, and subsequently developed by working groups with interest in the specified areas. PHPT is a common endocrine disease. However, its differential diagnosing to familial hypocalciuric hypercalcemia (FHH), the definition and clinical course of normocalcemic PHPT, and the optimal management of its recurrence after surgery represent areas of uncertainty requiring clarifications. HypoPT is an orphan disease characterized by low calcium concentrations due to insufficient PTH secretion, most often secondary to neck surgery. Prevention and prediction of surgical injury to the parathyroid glands are essential to limit the disease-related burden. Long-term treatment modalities including the place for PTH replacement therapy and the optimal biochemical monitoring and imaging surveillance for complications to treatment in chronic HypoPT, need to be refined. The physiological changes in calcium metabolism occurring during pregnancy and lactation modify the clinical presentation and management of parathyroid disorders in these periods of life. Modern interdisciplinary approaches to PHPT and HypoPT in pregnant and lactating women and their newborns children are proposed. The recommendations on clinical management presented here will serve as background for further educational material aimed for a broader clinical audience, and were developed with focus on endocrinologists in training.

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“…In our patients, persistent disease accounted for 12% and mostly included cases that underwent excision of only one or two parathyroid glands. The rate of recurrent disease on the other hand, although no consistent data are available, is reported to range between 2.5 and 9.8% [ 29 ] and can be developed up to 20 years after the initial parathyroid surgery, as we report in one of our patients. In these cases, localization for possible ectopic parathyroid tissue, using advanced imaging modalities such as 18F-fluorocholine PET/CT, should be considered [ 30 ], and long-term, yearly monitoring of calcium concentrations after a successful parathyroid surgery is strongly recommended [ 30 ].…”

Section: Discussionmentioning

confidence: 59%

Management and Long-Term Follow-Up of Hyperparathyroidism in Multiple Endocrine Neoplasia Type 1: Single Center Experience

Yavropoulou

Vlachou

Tsoli

et al. 2022

JCM

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Background: Primary hyperparathyroidism (PHPT) in the most common and earliest manifestation of multiple endocrine neoplasia type-1 (MEN1). Epidemiological data have been reported in MEN1 patients but data on long-term follow-up focusing on PHPT are scarce. Methods: In this retrospective cohort study, we included patients diagnosed with MEN1-related PHPT that were under regular follow-up in our institution. Results: Data on 68 patients (39 males), with a mean age at MEN1-diagnosis of 39 ± 13.06 years, were analyzed. Pancreatic neuroendocrine tumors were encountered in 82% (71% nonsecreting) followed by pituitary adenomas in 66% (49% nonsecreting). Mean age at PHPT diagnosis was 35.2 ± 4.0 years. Parathyroidectomy was performed in 57 patients (82.3%), of whom 56% achieved long-term remission, while 12.2% and 31.5% had persistent and recurrent disease, respectively (median follow-up of 4 years; range 1–21 years). Cinacalcet restored serum calcium levels in 33.8%, both as first and as a second line treatment. Permanent hypoparathyroidism occurred in 19.2%. MEN1 pathogenic variants were identified in 77.2% of the tested individuals, but no genotype-phenotype associations were reported. Conclusions: MEN1-related PHPT involves a multiglandular disease and its management remains a therapeutic challenge, as recurrent disease can develop even after 20 years of follow-up. Prolonged follow-up of these patients at referral centers is critical for their optimal management.

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Early biochemical response to parathyroidectomy for primary hyperparathyroidism and its predictive value for recurrent hypercalcemia and recurrent primary hyperparathyroidism

Cited by 13 publications

References 15 publications

Delayed Calcium Normalization after Successful Parathyroidectomy in Primary Hyperparathyroidism

Delayed Calcium Normalization after Successful Parathyroidectomy in Primary Hyperparathyroidism

European expert consensus on practical management of specific aspects of parathyroid disorders in adults and in pregnancy: recommendations of the ESE Educational Program of Parathyroid Disorders (PARAT 2021)

Management and Long-Term Follow-Up of Hyperparathyroidism in Multiple Endocrine Neoplasia Type 1: Single Center Experience

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